Individual provider Active NPI

Lolita Christine Jerrell, BSN

  • Hemodialysis Registered Nurse
  • Douglasville, GA
National Provider Identifier
1316523368
Registry record updated Mar 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hemodialysis Registered NurseTaxonomy code 163WH0500X
License
255603 Issued in GA
Practice address
4183 Leola Rd
Douglasville, GA 30135-4215
Phone
(404) 642-4995
NPI assigned
Mar 21, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hemodialysis Registered Nurse 163WH0500X 255603 GA Primary

Addresses

Primary practice location

4183 Leola Rd
Douglasville, GA 30135-4215

Mailing address

4183 Leola Rd
Douglasville, GA 30135-4215
Phone (404) 642-4995

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Bachelor on Science - Nursing

State licenses

LicenseStateTypeSpecialty
255603GAMDHemodialysis Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616284800000",
    "number": "1316523368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4183 LEOLA RD",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301354215",
            "telephone_number": "404-642-4995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4183 LEOLA RD",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301354215",
            "telephone_number": "404-642-4995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERRELL",
        "first_name": "LOLITA",
        "middle_name": "CHRISTINE",
        "credential": "BSN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-21",
        "last_updated": "2021-03-21",
        "certification_date": "2021-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Hemodialysis",
            "state": "GA",
            "license": "255603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.