Individual
MRS. JESSICA R COBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
100 MARKET PLACE BLVD STE 301, CARTERSVILLE, GA 30121-8717
(678) 290-4817
Mailing address
1452 CHESTER HARRIS DR N, DALLAS, GA 30132-0368
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
23255
SC
363LF0000X
Family Nurse Practitioner
Primary
RN330929
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PG1120
—
SC
Enumeration date
10/06/2019
Last updated
10/09/2024
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