Provider Demographics
NPI:1851165054
Name:JAJI, ADAEZE
Entity type:Individual
Prefix:
First Name:ADAEZE
Middle Name:
Last Name:JAJI
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 1:892 DUNLIN FIELDS DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-7812
Mailing Address - Country:US
Mailing Address - Phone:404-863-6462
Mailing Address - Fax:
Practice Address - Street 1:805 EAGLERIDGE BLVD STE 140
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2354
Practice Address - Country:US
Practice Address - Phone:719-679-5022
Practice Address - Fax:719-888-1673
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN284878163WP0808X
COAPN.1000862-NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health