Provider Demographics
NPI:1679243232
Name:COMBS, JESSE M (AUD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:M
Last Name:COMBS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 N BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3000
Mailing Address - Country:US
Mailing Address - Phone:706-868-5676
Mailing Address - Fax:706-722-2824
Practice Address - Street 1:340 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3000
Practice Address - Country:US
Practice Address - Phone:706-868-5676
Practice Address - Fax:706-722-2824
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004299231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist