Individual
JESSICA FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
745 POPLAR RD, NEWNAN, GA 30265-1618
(770) 400-1000
Mailing address
1505 16TH AVE, COLUMBUS, GA 31901-2083
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F06170504
GA
Other
Enumeration date
06/19/2017
Last updated
06/19/2017
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