Individual
DAMON KEITH JESSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1 MEADOWS PKWY, VIDALIA, GA 30474-8759
(912) 538-5537
(912) 538-5228
Mailing address
PO BOX 1303, VIDALIA, GA 30475-1303
(912) 538-5537
(912) 538-5228
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN131653
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
462913918A
—
GA
05
—
462913918B
—
GA
05
—
462913918C
—
GA
Enumeration date
01/24/2008
Last updated
08/27/2015
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