Provider Demographics
NPI:1861687063
Name:SWILLEY, JESSICA VEANN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:VEANN
Last Name:SWILLEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1270 PRINCE AVE STE 308
Mailing Address - Street 2:ATHENS HEALTHCARE FOR WOMEN PC
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2727
Mailing Address - Country:US
Mailing Address - Phone:706-552-1600
Mailing Address - Fax:706-552-5370
Practice Address - Street 1:1270 PRINCE AVENUE
Practice Address - Street 2:SUITE 308
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30306
Practice Address - Country:US
Practice Address - Phone:706-552-1600
Practice Address - Fax:706-552-5370
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR7170870363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01296825OtherAMERIGROUP
GA25902OtherKAISER
GA532560OtherWELLCARE
GA613458411AMedicaid
GA532560OtherWELLCARE
GA511I500193Medicare UPIN