Provider Demographics
NPI:1952360653
Name:JAY, JOAN EILEEN (CRNA)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:EILEEN
Last Name:JAY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 BELLEFONTE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8195
Mailing Address - Country:US
Mailing Address - Phone:770-822-6824
Mailing Address - Fax:
Practice Address - Street 1:2620 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1204
Practice Address - Country:US
Practice Address - Phone:404-785-8000
Practice Address - Fax:404-785-8001
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN100447367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
43ZCCCT17Medicare ID - Type Unspecified
S26268Medicare UPIN