Individual
JACOB PAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-6124
(229) 353-7722
Mailing address
209 TILLMAN PAULK RD, AMBROSE, GA 31512-3486
(229) 548-5137
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN181759
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN181759
STATE LICENSE
GA
Enumeration date
04/12/2011
Last updated
12/16/2020
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