Individual
JENNIFER B. SISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2383 PATE ST N, SNELLVILLE, GA 30078-3250
(770) 972-4845
Mailing address
1609 MAPMAKER DR, DACULA, GA 30019-7818
(404) 788-4321
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004267
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
824570839A
—
GA
Enumeration date
02/23/2006
Last updated
03/17/2018
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