Jortay Diagnostic

Primary specialty

Physiological LaboratoryTaxonomy code 293D00000X

Legal business name

JORTAY DIAGNOSTIC

Practice address

1290 Kennestone Circle
Building a, Suite 112
Marietta, GA 30066-6009

Phone

(770) 364-2184

NPI assigned

Feb 25, 2020

Last updated

Feb 25, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tamika Goins

Title

Managing Partner

Phone

(770) 364-2184

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1477187847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1157",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301881157",
            "telephone_number": "770-364-2184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 KENNESTONE CIRCLE",
            "address_2": "BUILDING A, SUITE 112",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300666009",
            "telephone_number": "770-364-2184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORTAY DIAGNOSTIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "GOINS",
        "authorized_official_first_name": "TAMIKA",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "770-364-2184"
    },
    "taxonomies": [
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Jordan
• Samantha R Jordan, PSYD
• Sheniqueka Jordan
• Wronda Jo Jordan, CNM
• Camille Jorek
• Jose Goncalves PC
• Jose Goncalves, OD
• Joseph L. Micca, MD
• Claudia Joseph, RBT
• Jenny Joseph, MD

• Physiological Laboratory in Marietta, GA
• Providers in Marietta, GA by specialty
• Physiological Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.