Provider Demographics
NPI:1265317747
Name:JACOBS, LAKANYA DAWNIELLE
Entity type:Individual
Prefix:
First Name:LAKANYA
Middle Name:DAWNIELLE
Last Name:JACOBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 KATELEN CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7720
Mailing Address - Country:US
Mailing Address - Phone:404-951-2000
Mailing Address - Fax:
Practice Address - Street 1:7485 FACTORY SHOALS RD STE B2
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-7660
Practice Address - Country:US
Practice Address - Phone:404-951-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist