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NPI Code Detail

MEDICARE: JENNIFER KELSIE FUSSELL APC

MEDICARE: JENNIFER KELSIE FUSSELL APC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorAPC800564GA

General Provider Information

NPI Number : 1235847302
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER KELSIE FUSSELL APC
Provider Business Mailing Address
First Line : 101 E MEMORIAL DR
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-2727
Country : US
Telephone Number : 912-876-4010
Fax Number :
Provider Business Practice Location Address
First Line : 101 E MEMORIAL DR
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-2727
Country : US
Telephone Number : 912-876-4010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2022
Last Update Date : 11/08/2022

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