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Individual

JESSICA LYN MENARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
840 PINE ST, SUITE 880, MACON, GA 31201
(478) 743-7092
(478) 743-6293
Mailing address
840 PINE ST STE 880, MACON, GA 31201-7525
(478) 743-7092
(478) 743-6293

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
4132
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
700604110A
GA
Enumeration date
06/01/2006
Last updated
01/13/2022
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