Healthcare Provider Details

I. General information

NPI: 1871931733
Provider Name (Legal Business Name): EMILY JOY JENSEN BROWN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY JOY JENSON

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW BUILDING 77, 6TH FLOOR
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

1968 PEACHTREE RD NW BUILDING 77, 6TH FLOOR
ATLANTA GA
30309-1281
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2905
  • Fax: 678-244-6608
Mailing address:
  • Phone: 404-605-2905
  • Fax: 678-244-6608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005693
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6864
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: