Individual
JAIBA PAUL MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
980 JOHNSON FY RD NE, ATLANTA, GA 30342-1626
(404) 252-0256
(404) 252-0256
Mailing address
840 STREAMVIEW WAY, ALPHARETTA, GA 30004-5954
(832) 692-8396
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN207189
GA
363LA2200X
Adult Health Nurse Practitioner
RN207189
GA
Other
Enumeration date
07/08/2020
Last updated
07/08/2020
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