Provider Demographics
NPI:1467769943
Name:EDWARDS, JESSICA R (PA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:R
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:R
Other - Last Name:FORBES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:SUITE B1400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-4898
Mailing Address - Fax:404-778-4006
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:SUITE B1400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-4898
Practice Address - Fax:404-778-4006
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005905363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical