Provider Demographics
NPI:1316604226
Name:LAJONQUILLE, SIMONE B (LPN)
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:B
Last Name:LAJONQUILLE
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 1:1199 SAXONY DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1774
Mailing Address - Country:US
Mailing Address - Phone:404-399-8720
Mailing Address - Fax:833-323-2345
Practice Address - Street 1:1199 SAXONY DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1774
Practice Address - Country:US
Practice Address - Phone:404-399-8720
Practice Address - Fax:833-323-2345
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN099128164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse