Basic Information
| Provider Information | |||||||||
| NPI: | 1225502768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZZIWA | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | KABAHUMA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1947 ARBOR CREEK CT | ||||||||
| Address2: | |||||||||
| City: | BUFORD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305192280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044532337 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4072 ATLANTA HIGH WAY | ||||||||
| Address2: | |||||||||
| City: | LOGANVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066217575 | ||||||||
| FaxNumber: | 7066217557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2019 | ||||||||
| LastUpdateDate: | 07/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN169490 | GA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.