Jac Nursing Registry International Inc

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

041157362 Issued in GA

Legal business name

JAC NURSING REGISTRY INTERNATIONAL INC

Doing business as

Jac Nursing Registry internatl Inc

Practice address

4500 Hugh Howell Rd
320
Tucker, GA 30084-4723

Phone

(770) 753-9070

Fax

(770) 621-9433

NPI assigned

Nov 3, 2008

Last updated

Nov 3, 2008By 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

Ms. Chris Moody, CBCS

Title

Pracrice Manager

Phone

(678) 705-2633

Specialties & licenses 2

Addresses

Other names 1

• Jac Nursing Registry internatl Inc Doing business as

Locations

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

{
    "created_epoch": "1225670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225670400000",
    "number": "1972756054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7078 BILTMORE TRCE",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300582962",
            "telephone_number": "770-753-9070",
            "fax_number": "770-621-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 HUGH HOWELL RD",
            "address_2": "320",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300844723",
            "telephone_number": "770-753-9070",
            "fax_number": "770-621-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAC NURSING REGISTRY INTERNATIONAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-03",
        "last_updated": "2008-11-03",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "PRACRICE MANAGER",
        "authorized_official_telephone_number": "678-705-2633",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CBCS"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "GA",
            "license": "041157362",
            "primary": true
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "",
            "desc": "Day Training/Habilitation Specialist",
            "state": "GA",
            "license": "041157362",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jac Nursing Registry internatl Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Whitney Chivonne Irie, PHD
• Stephanie Elise Isaacson, DPT
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• J G Options, LLC
• Samiya Jabir
• Lamont Joseph Jack, PTA
• Jarrett Roux Jackson, M.ED., CCC-SLP
• Jessica J Jackson, LPC
• Justin M. Jackson, M.D.
• Kaela Jackson, LAMFT

• Adult Care Home Facility in Tucker, GA
• Providers in Tucker, GA by specialty
• Adult Care Home Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; 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.