Provider Demographics
NPI:1003798638
Name:LOCKE, JACOB HUNTER (RN)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:HUNTER
Last Name:LOCKE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4845
Mailing Address - Country:US
Mailing Address - Phone:678-677-6297
Mailing Address - Fax:
Practice Address - Street 1:215 KIRKLAND RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-3318
Practice Address - Country:US
Practice Address - Phone:678-209-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN326511163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse