Healthcare Provider Details

I. General information

NPI: 1730896242
Provider Name (Legal Business Name): BENJAMIN H JESSEE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2022
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 PEACH ORCHARD RD STE 200
AUGUSTA GA
30906-2406
US

IV. Provider business mailing address

2604 PEACH ORCHARD RD STE 200
AUGUSTA GA
30906-2406
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-0600
  • Fax: 706-922-0603
Mailing address:
  • Phone: 706-922-0600
  • Fax: 706-922-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14270
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: