Individual
JESSICA NICOLE BREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1267 HIGHWAY 54 W STE 2200, FAYETTEVILLE, GA 30214-2110
(770) 716-0051
Mailing address
195 COWETA LAKE RD, NEWNAN, GA 30265-1815
(404) 226-4836
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN239680
GA
363L00000X
Nurse Practitioner
Primary
APRN-NP239680
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
239680
—
GA
Enumeration date
07/23/2020
Last updated
09/16/2025
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