Individual
JESSICA LEANN NIEVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
165 N PARK TRL, STOCKBRIDGE, GA 30281
(770) 506-1800
Mailing address
304 COBBLESTONE BLVD, STOCKBRIDGE, GA 30281-7306
(334) 791-7930
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
008628
GA
Other
Enumeration date
12/14/2017
Last updated
02/03/2019
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