Individual
JESSICA LOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
791 POPLAR ST, MACON, GA 31201-2045
(478) 755-8838
Mailing address
791 POPLAR ST, MACON, GA 31201-2045
(478) 755-8838
Taxonomy
Speciality
Code
Description
License number
State
163WM0102X
Maternal Newborn Registered Nurse
RN258772
GA
363LF0000X
Family Nurse Practitioner
Primary
RN258772
GA
Other
Enumeration date
06/28/2020
Last updated
07/22/2020
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