Provider Demographics
NPI:1336748409
Name:DENSON, JESSE AARON (CSA)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:AARON
Last Name:DENSON
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-0081
Mailing Address - Country:US
Mailing Address - Phone:678-517-3428
Mailing Address - Fax:770-485-1534
Practice Address - Street 1:2046 POINT GREY CT NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-8276
Practice Address - Country:US
Practice Address - Phone:678-517-3428
Practice Address - Fax:770-485-1534
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5172363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical