Provider Demographics
NPI:1649961954
Name:BOYLE, JESSICA ANN
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ANN
Last Name:BOYLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3302 MILLHOLLOW TER
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7933
Mailing Address - Country:US
Mailing Address - Phone:770-401-1968
Mailing Address - Fax:
Practice Address - Street 1:1325 SATELLITE BLVD NW STE 400
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-5299
Practice Address - Country:US
Practice Address - Phone:678-263-3080
Practice Address - Fax:678-496-9863
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN170737163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health