Healthcare Provider Details

I. General information

NPI: 1285378695
Provider Name (Legal Business Name): JESSICA NEWTON EHINGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA CATHERINE NEWTON

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 PEACHTREE DUNWOODY RD STE G65
ATLANTA GA
30342-1710
US

IV. Provider business mailing address

4315 PARKSIDE PL
SANDY SPRINGS GA
30342-2902
US

V. Phone/Fax

Practice location:
  • Phone: 404-843-3323
  • Fax: 404-574-5944
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN278765
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN278765
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: