Provider Demographics
NPI:1417967126
Name:MORSE, JESSICA NEVINS (MD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:NEVINS
Last Name:MORSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:RENE
Other - Last Name:NEVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:335 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2363
Practice Address - Country:US
Practice Address - Phone:207-662-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27083207R00000X
GA062746207R00000X
ME24035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC270833Medicaid
SC576007863093OtherBCBS OF SC
SCP00615796OtherRR MEDICARE
SCAA19536904Medicare PIN
SC270833Medicaid
SCAA19537951Medicare PIN