Provider Demographics
NPI:1497767131
Name:MCCABE, JESSICA ANN (DO)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:MCCABE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6325 HOSPITAL PKWY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-5775
Mailing Address - Country:US
Mailing Address - Phone:770-712-4616
Mailing Address - Fax:770-495-1585
Practice Address - Street 1:6325 HOSPITAL PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-5775
Practice Address - Country:US
Practice Address - Phone:770-712-4616
Practice Address - Fax:770-495-1585
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200737207L00000X
GA061494207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132GMedicaid
NC89132GMedicaid
2401275AMedicare ID - Type Unspecified