Provider Demographics
NPI:1487332284
Name:CHARBONNEAU, JONI JACKSON (PMHNP)
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:JACKSON
Last Name:CHARBONNEAU
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:MELINDA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-0964
Mailing Address - Country:US
Mailing Address - Phone:888-772-0076
Mailing Address - Fax:
Practice Address - Street 1:1332 WESTON DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2551
Practice Address - Country:US
Practice Address - Phone:678-237-5538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP001470363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health