Provider Demographics
NPI:1962053173
Name:NEILL, JAIME
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:NEILL
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 1:17139 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:GA
Mailing Address - Zip Code:30557-3324
Mailing Address - Country:US
Mailing Address - Phone:706-244-0854
Mailing Address - Fax:
Practice Address - Street 1:17139 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:GA
Practice Address - Zip Code:30557-3324
Practice Address - Country:US
Practice Address - Phone:706-244-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherDEPARTMENT OF VA