Healthcare Provider Details

I. General information

NPI: 1467769943
Provider Name (Legal Business Name): JESSICA R EDWARDS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA R FORBES P.A.

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE SUITE B1400
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE SUITE B1400
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4898
  • Fax: 404-778-4006
Mailing address:
  • Phone: 404-778-4898
  • Fax: 404-778-4006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005905
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number005905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: