Active NPI
Jacinta Lake Thomas, DNP, APRN-C
- Family Nurse Practitioner
- Atlanta, GA
National Provider Identifier
1972592699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- RN117444
- Practice address
- 865 N Highland Ave NE
Atlanta, GA 30306-4565 - Phone
- (404) 733-6089
- Fax
- (612) 659-7101
- NPI assigned
- Oct 15, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | RN117444 | GA | Primary |
Addresses
Primary practice location
865 N Highland Ave NE
Atlanta, GA 30306-4565
Mailing address
1717 Bennett Dr
McDonough, GA 30253-9039
Phone (678) 787-8647
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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Care PLLC | Family | Current | Accepting new patients |
Locations
865 N Highland Ave NE
Atlanta, GA 30306
Phone (404) 733-6089
11710 Alpharetta Hwy
Roswell, GA 30076
Phone (770) 754-0141
Networks
- Healthfirst Medicare Network H3359
- Healthfirst Medicare Network H1722
- Healthfirst Medicare Network H9678
- Healthfirst Medicare Network H5989
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362528000000",
"number": "1972592699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1717 BENNETT DR",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302539039",
"telephone_number": "678-787-8647"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "865 N HIGHLAND AVE NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303064565",
"telephone_number": "404-733-6089",
"fax_number": "612-659-7101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "JACINTA",
"middle_name": "LAKE",
"name_prefix": "Mrs.",
"credential": "DNP, APRN-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-15",
"last_updated": "2013-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "GA",
"license": "RN117444",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.