Individual
JESSE MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA-C
Contact information
Practice address
380 HOSPITAL DR STE 410, MACON, GA 31217-8014
(478) 746-5644
(478) 745-4849
Mailing address
380 HOSPITAL DR STE 410, MACON, GA 31217-8014
(478) 746-5644
(478) 745-4849
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
008537
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
GA
Enumeration date
10/10/2017
Last updated
06/16/2018
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