Healthcare Provider Details

I. General information

NPI: 1386965598
Provider Name (Legal Business Name): JESSICA CASTLEBERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 JOE FRANK HARRIS PKWY SE STE 120
CARTERSVILLE GA
30120-2160
US

IV. Provider business mailing address

917 W GORDON ST
THOMASTON GA
30286-3427
US

V. Phone/Fax

Practice location:
  • Phone: 470-490-3135
  • Fax:
Mailing address:
  • Phone: 706-647-9627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number71912
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4145
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: