Provider Demographics
NPI:1215773122
Name:THOMAS, JAKELL (DIRECTOR)
Entity type:Individual
Prefix:
First Name:JAKELL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 KARIS CT
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4878
Mailing Address - Country:US
Mailing Address - Phone:229-460-0006
Mailing Address - Fax:
Practice Address - Street 1:103 KARIS CT
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4878
Practice Address - Country:US
Practice Address - Phone:229-460-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAQ6H5B5D5374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician