Provider Demographics
NPI:1770848020
Name:NORRIS, JESSICA ELAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:ELAINE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5445 MERIDIAN MARKS RD STE 380
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4755
Mailing Address - Country:US
Mailing Address - Phone:404-705-3100
Mailing Address - Fax:404-705-3040
Practice Address - Street 1:5445 MERIDIAN MARKS RD STE 380
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4755
Practice Address - Country:US
Practice Address - Phone:404-705-3100
Practice Address - Fax:404-705-3040
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2012016268208000000X
GA73578208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003158335AMedicaid