Provider Demographics
NPI:1750991592
Name:MCCRACKEN, JAMIE RAE (APRN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:RAE
Last Name:MCCRACKEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 GORDON CIR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-8123
Mailing Address - Country:US
Mailing Address - Phone:404-775-1276
Mailing Address - Fax:
Practice Address - Street 1:2538 GORDON CIR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8123
Practice Address - Country:US
Practice Address - Phone:404-775-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN246546363LP0808X
GARN246456363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty