MEDICARE: JESSICA LYNNE SCHWARTZ RN

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
1	163W00000X	Registered Nurse	RN217123	GA

General Provider Information

NPI Number	:	1578271425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNNE SCHWARTZ RN

Provider Business Mailing Address
First Line	:	631 HARDIN RD
Second Line	:
City	:	TEMPLE
State	:	GA
Zip	:	30179-2735
Country	:	US
Telephone Number	:	770-324-8354
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 ENTERPRISE PATH STE 104A
Second Line	:
City	:	HIRAM
State	:	GA
Zip	:	30141-2655
Country	:	US
Telephone Number	:	678-427-2874
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2022
Last Update Date	:	11/09/2022

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