Healthcare Provider Details

I. General information

NPI: 1912132218
Provider Name (Legal Business Name): JESSICA L CIOFFI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2009
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW BLDG 775TH
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-4600
  • Fax:
Mailing address:
  • Phone: 352-265-0889
  • Fax: 352-265-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME124836
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01074001A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number85000
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: