Provider Demographics
NPI:1205245289
Name:WASSON, JESSICA LEIGH (PA-C)
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LEIGH
Last Name:WASSON
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 1:7580 SPRINGBOX DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-1287
Mailing Address - Country:US
Mailing Address - Phone:770-892-4133
Mailing Address - Fax:770-774-7218
Practice Address - Street 1:7580 SPRINGBOX DR
Practice Address - Street 2:SUITE 250
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-1287
Practice Address - Country:US
Practice Address - Phone:770-892-4133
Practice Address - Fax:770-774-7218
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant