Individual
MS. JESSICA NICOLE MATHIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
132 OLD NORTON RD, SUITE 200, FAYETTEVILLE, GA 30215-4872
(678) 817-1117
(678) 817-0823
Mailing address
1835 SAVOY DR, SUITE 300, ATLANTA, GA 30341-1072
(678) 817-1117
(678) 817-0823
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN164716
GA
363LF0000X
Family Nurse Practitioner
RN164716
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003169046B
—
GA
Enumeration date
06/24/2015
Last updated
08/19/2020
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