Provider Demographics
NPI:1679305692
Name:MACK, JAMEKA DANIELLE
Entity type:Individual
Prefix:
First Name:JAMEKA
Middle Name:DANIELLE
Last Name:MACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:MACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CD, CPD
Mailing Address - Street 1:2696 WINDROCK CT
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1720
Mailing Address - Country:US
Mailing Address - Phone:404-207-7194
Mailing Address - Fax:
Practice Address - Street 1:2696 WINDROCK CT
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-1720
Practice Address - Country:US
Practice Address - Phone:404-207-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula