Individual provider Active NPI

Jolie Alexis Puckett, NP

  • Acute Care Nurse Practitioner
  • Rome, GA
National Provider Identifier
1386473403
Registry record updated Sep 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
RN268423 Issued in GA
Practice address
304 Turner McCall Blvd SW
Rome, GA 30165-5621
Phone
(706) 509-5000
NPI assigned
Jul 29, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X RN268423 GA Primary

Addresses

Primary practice location

304 Turner McCall Blvd SW
Rome, GA 30165-5621

Mailing address

253 Chubbtown Rd
Cedartown, GA 30125-4330
Phone (678) 988-6179

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241219004293 GA Practitioner - Nurse Practitioner 1254868839 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
24 On Physicians PCGroup PAC ID 5698688141, 274 clinicians

Practice addresses (Care Compare)

304 Turner McCall Blvd SW
Rome, GA 30165-5621
Phone (706) 509-4340

Hospital & facility affiliations

  • Atrium Health Floyd Medical Center Hospital, Rome, GA, CCN 110054
  • Atrium Health Floyd Polk Medical Center Hospital, Cedartown, GA, CCN 111330
  • Floyd Cherokee Medical Center Hospital, Centre, AL, CCN 010022

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
24 On Physicians, PC Hospitalist CurrentSince Oct 16, 2024 Accepting new patients
24 On Physicians, P.C. Hospitalist CurrentSince Oct 16, 2024 Accepting new patients

Locations

13000 Deerfield Pkwy
Ste 100
Alpharetta, GA 30004

304 Turner McCall Blvd SW
Rome, GA 30165
Phone (706) 506-5000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1722211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1386473403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "253 CHUBBTOWN RD",
            "city": "CEDARTOWN",
            "state": "GA",
            "postal_code": "301254330",
            "telephone_number": "678-988-6179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 TURNER MCCALL BLVD SW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301655621",
            "telephone_number": "706-509-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "JOLIE",
        "middle_name": "ALEXIS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-29",
        "last_updated": "2024-09-10",
        "certification_date": "2024-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN268423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rome, GA

Sources for this page

Verify at the official NPI Registry.