Provider Demographics
NPI:1447079082
Name:ADAIR, JACLYN BERRY (NP)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:BERRY
Last Name:ADAIR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:LEE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1306 CONCOURSE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3370 PADDOCKS PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-9119
Practice Address - Country:US
Practice Address - Phone:770-814-8222
Practice Address - Fax:678-205-5111
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN322183363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner