Provider Demographics
NPI:1932866068
Name:MCNISH, JAMILA HADIYA MASIKA (LPN)
Entity Type:Individual
Prefix:
First Name:JAMILA
Middle Name:HADIYA MASIKA
Last Name:MCNISH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N MLK JR DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6318
Mailing Address - Country:US
Mailing Address - Phone:229-379-1136
Mailing Address - Fax:
Practice Address - Street 1:227 E HILL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6134
Practice Address - Country:US
Practice Address - Phone:229-379-1136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN080016164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse