Healthcare Provider Details

I. General information

NPI: 1174456800
Provider Name (Legal Business Name): JESSICA D FELTS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FERRY RD NE
ATLANTA GA
30342
US

IV. Provider business mailing address

PO BOX 834
TUCKER GA
30085-0834
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP282755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: