Provider Demographics
NPI:1518588326
Name:CISNEROS, JESSICA (RT (R))
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:RT (R)
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:CISNEROS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RT (R)
Mailing Address - Street 1:70 PERIMETER CTR E APT 1438
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-1828
Mailing Address - Country:US
Mailing Address - Phone:706-618-0106
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1611
Practice Address - Country:US
Practice Address - Phone:404-851-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-03
Last Update Date:2020-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5761162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology