Organization
JETT SURGICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY KAE JETTON CSA (CEO)
(770) 842-1907
Entity
Organization
Contact information
Practice address
915 RANDALL CT NW, MARIETTA, GA 30064-4724
(770) 842-1907
(678) 214-5098
Mailing address
PO BOX 422252, ATLANTA, GA 30342-9252
(770) 842-1907
(678) 214-5098
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
1256
GA
Other
Enumeration date
10/19/2016
Last updated
12/12/2016
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