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Individual

JEWETT MUKENGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
A-GNP-C

Contact information

Practice address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(706) 733-0188
(706) 731-7243
Mailing address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(706) 733-0188

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN129478
GA
363LA2200X
Adult Health Nurse Practitioner
RN129478
GA
363LG0600X
Gerontology Nurse Practitioner
RN129478
GA

Other

Enumeration date
11/20/2015
Last updated
10/18/2019
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