Individual
JORGE ROBERTO MENJIVAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
105 HONEY LN, MCDONOUGH, GA 30252-6633
(803) 873-8626
(803) 878-8099
Mailing address
105 HONEY LN, MCDONOUGH, GA 30252-6633
(678) 466-0803
(770) 692-8177
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN204394
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10006776
LICENSE
OR
01
—
865069
LICENSE
NV
01
—
95026632
LICENSE
CA
01
—
AP61443567
LICENSE
WA
01
—
RN204394
LICENSE
GA
Enumeration date
03/14/2017
Last updated
07/29/2025
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