Provider Demographics
NPI:1609484799
Name:STEELE, JESSICA (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STEELE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:SAUTEE NACOOCHEE
Mailing Address - State:GA
Mailing Address - Zip Code:30571-3809
Mailing Address - Country:US
Mailing Address - Phone:770-377-4543
Mailing Address - Fax:
Practice Address - Street 1:211 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:SAUTEE NACOOCHEE
Practice Address - State:GA
Practice Address - Zip Code:30571-3809
Practice Address - Country:US
Practice Address - Phone:770-377-4543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9781363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant