Individual
DR. JESSICA AGNES KOBLEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 535-3611
(770) 535-7092
Mailing address
PO BOX 658, GAINESVILLE, GA 30503-0658
(770) 533-6511
(770) 533-4786
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
064662
GA
208000000X
Pediatrics Physician
29977
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
731872400B
—
GA
05
—
731872400D
—
GA
05
—
GA1079
—
SC
01
—
P01069469
RAILROAD MEDICARE
GA
Enumeration date
06/28/2007
Last updated
03/06/2019
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