Provider Demographics
NPI:1508496845
Name:WU, JEREMY KENT (CERTIFIED PA)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:KENT
Last Name:WU
Suffix:
Gender:M
Credentials:CERTIFIED PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1930 BRANNAN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4310
Mailing Address - Country:US
Mailing Address - Phone:678-284-4040
Mailing Address - Fax:678-284-4076
Practice Address - Street 1:850 LAWRENCEVILLE SUWANEE RD STE 101
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5483
Practice Address - Country:US
Practice Address - Phone:770-963-2451
Practice Address - Fax:770-962-0017
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006024363AS0400X
MEPA2032363AS0400X
SC4084363AS0400X
GA12810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical