Provider Demographics
NPI:1114636859
Name:PARKER, JESSICA ANNE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:PARKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 WHITAKER RD
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:GA
Mailing Address - Zip Code:30814-4718
Mailing Address - Country:US
Mailing Address - Phone:706-755-8549
Mailing Address - Fax:
Practice Address - Street 1:887 W MARIETTA ST NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-5252
Practice Address - Country:US
Practice Address - Phone:888-772-0076
Practice Address - Fax:770-751-8014
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily