Individual
MR. JERETT STOCKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1001 JOHNSON FERRY RD, ATLANTA, GA 30342-1605
(404) 785-4258
Mailing address
1001 BUCKEYE LN, VILLA RICA, GA 30180-5328
(678) 850-0985
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN263866
GA
Other
Enumeration date
02/02/2021
Last updated
05/08/2023
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