Provider Demographics
NPI:1952637944
Name:LAMB, JESSICA MULLIS (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MULLIS
Last Name:LAMB
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BOWLING LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2502
Mailing Address - Country:US
Mailing Address - Phone:478-272-0203
Mailing Address - Fax:478-272-0223
Practice Address - Street 1:102 BOWLING LN
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2502
Practice Address - Country:US
Practice Address - Phone:478-272-0203
Practice Address - Fax:478-272-0223
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN163024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA460946308CMedicaid
GA460946308BMedicaid