Provider Demographics
NPI:1700938552
Name:POOLE, JESSICA M (MED, ATC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:M
Last Name:POOLE
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Gender:F
Credentials:MED, ATC
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Mailing Address - Street 1:82 COLLEGE CIRCLE NGCSU
Mailing Address - Street 2:HPE ATHLETICS
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30597-0001
Mailing Address - Country:US
Mailing Address - Phone:706-864-1875
Mailing Address - Fax:706-867-2865
Practice Address - Street 1:82 COLLEGE CIRCLE NGCSU
Practice Address - Street 2:HPE ATHLETICS
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30597-0001
Practice Address - Country:US
Practice Address - Phone:706-864-1875
Practice Address - Fax:706-867-2865
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GAAT0008732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer