Provider Demographics
NPI:1508546763
Name:LOCKETT, JAIEL (PA-C)
Entity type:Individual
Prefix:
First Name:JAIEL
Middle Name:
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAIEL
Other - Middle Name:
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:4300 N POINT PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4102
Mailing Address - Country:US
Mailing Address - Phone:770-442-1911
Mailing Address - Fax:
Practice Address - Street 1:1150 HAMMOND DR STE 310
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-7500
Practice Address - Country:US
Practice Address - Phone:678-802-5780
Practice Address - Fax:770-557-3568
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12856363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant