Provider Demographics
NPI:1881154979
Name:ATKINS, JADA
Entity type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:ATKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SPRUCE ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3901
Mailing Address - Country:US
Mailing Address - Phone:800-240-5299
Mailing Address - Fax:
Practice Address - Street 1:320 SPRUCE ST APT 2A
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3901
Practice Address - Country:US
Practice Address - Phone:800-240-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver