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Individual

MRS. JESSICA G KOSMOWSKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
610 3RD ST, SUITE 206, MACON, GA 31201-3294
(478) 464-2600
Mailing address
101 PRINCETON DR, MACON, GA 31220-8739
(478) 737-0344

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN170482
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
466646813A
GA
01
580628385
TRICARE
GA
01
P00819053
RAILROAD MEDICARE
GA
Enumeration date
03/12/2010
Last updated
08/06/2013
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