Provider Demographics
NPI:1871764050
Name:EMMETT, JANA (PA-C)
Entity type:Individual
Prefix:MS
First Name:JANA
Middle Name:
Last Name:EMMETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 HAMMOND DR NE
Mailing Address - Street 2:STE B-2140
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5334
Mailing Address - Country:US
Mailing Address - Phone:678-731-9815
Mailing Address - Fax:678-731-9817
Practice Address - Street 1:1150 HAMMOND DR NE
Practice Address - Street 2:STE B-2140
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5334
Practice Address - Country:US
Practice Address - Phone:678-731-9815
Practice Address - Fax:678-731-9817
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant