Individual
JULIE JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-0545
(504) 842-2095
Mailing address
960 PEACHTREE INDUSTRIAL BLVD, SUWANEE, GA 30024-1995
(770) 831-8191
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200862
LA
363AM0700X
Medical Physician Assistant
7398
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07708858
—
MS
05
—
2426125
—
LA
Enumeration date
01/16/2015
Last updated
10/31/2016
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