Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jackline Wanga Gates

Individual provider Nurse Practitioner · NPI 1801432216

Jackline Wanga Gates is a Nurse Practitioner in Fayetteville, Georgia. Qualified in 2019, 7 years ago. Practices with Wellstreet of Georgia PC, a 431-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
7
Licensed in
GA
In the registry since
2019
Specialties on file
2
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Practice location Address checks out

1275 Highway 54 W Ste 201
Fayetteville, GA 30214-4538
Phone: (770) 461-3776
Fax: (770) 461-3565
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence APRN-NP313932 (GA)
Nurse Practitioner Taxonomy 363L00000X · Licence RN313932 (GA)

Record details

NPI number1801432216
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedNovember 20, 2019
Last updated in NPPESOctober 28, 2025
Certification dateOctober 28, 2025
Mailing address1275 Highway 54 W Ste 201, Fayetteville, GA 30214-4538

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Wellstreet Of Georgia Pc — 431 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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