Provider Demographics
NPI:1164004917
Name:IGBALAJOBI, JESSICA (PMHNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:IGBALAJOBI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13844
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-0844
Mailing Address - Country:US
Mailing Address - Phone:404-797-7919
Mailing Address - Fax:
Practice Address - Street 1:2801 BUFORD HWY NE STE 100
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2146
Practice Address - Country:US
Practice Address - Phone:678-820-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN233785363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health