Provider Demographics
NPI:1366652505
Name:GEORGIA JESSUP AND ASSOICATES
Entity Type:Organization
Organization Name:GEORGIA JESSUP AND ASSOICATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JESSUP
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC
Authorized Official - Phone:310-450-0666
Mailing Address - Street 1:2101 MARINE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-6039
Mailing Address - Country:US
Mailing Address - Phone:310-450-0666
Mailing Address - Fax:
Practice Address - Street 1:531 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2315
Practice Address - Country:US
Practice Address - Phone:213-683-9390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP2916282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital