Provider Demographics
NPI:1487312690
Name:NOLLEY, JAJUAN
Entity type:Individual
Prefix:
First Name:JAJUAN
Middle Name:
Last Name:NOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 MARBLE DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-4138
Mailing Address - Country:US
Mailing Address - Phone:470-262-8782
Mailing Address - Fax:
Practice Address - Street 1:148 MARBLE DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:GA
Practice Address - Zip Code:30054-4138
Practice Address - Country:US
Practice Address - Phone:470-262-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care