Provider Demographics
NPI:1215569843
Name:COLEY, JESSI'CA (MPH, CD(DONA))
Entity Type:Individual
Prefix:MS
First Name:JESSI'CA
Middle Name:
Last Name:COLEY
Suffix:
Gender:F
Credentials:MPH, CD(DONA)
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 961064
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-7064
Mailing Address - Country:US
Mailing Address - Phone:407-387-0522
Mailing Address - Fax:
Practice Address - Street 1:451 BROOKVIEW DR STE A
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-7206
Practice Address - Country:US
Practice Address - Phone:407-387-0522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 174N00000X, 175F00000X, 175M00000X
VA171000000X, 374J00000X, 376K00000X
GA172V00000X, 171400000X, 332BC3200X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoula
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopath
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No175M00000XOther Service ProvidersMidwife, Lay
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty