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Individual

JESSICA BROTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
1365 CLIFTON RD NE, ATLANTA, GA 30322-1013
(404) 778-8570
Mailing address
1365 CLIFTON RD NE, ATLANTA, GA 30322-1013
(404) 778-8570
(404) 778-8652

Taxonomy

Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
LC000233
GA
363LF0000X
Family Nurse Practitioner
Primary
RN175180
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003269528D
GA
Enumeration date
02/12/2022
Last updated
10/12/2025
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