Individual
JESSICA EBONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
148 BILL CARRUTH PKWY, HIRAM, GA 30141-3754
(470) 610-0145
Mailing address
8901 STONEBRIDGE BLVD STE 200, DOUGLASVILLE, GA 30134-2254
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7667
GA
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/19/2024
Last updated
03/24/2025
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