Provider Demographics
NPI:1568128809
Name:MOORE, JESSICA MORGAN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MORGAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 HARDWOOD RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ADAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30103-2018
Mailing Address - Country:US
Mailing Address - Phone:404-309-3441
Mailing Address - Fax:
Practice Address - Street 1:171 HARDWOOD RIDGE DR
Practice Address - Street 2:
Practice Address - City:ADAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30103-2018
Practice Address - Country:US
Practice Address - Phone:404-309-3441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA220464363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care