Healthcare Provider Details

I. General information

NPI: 1992669725
Provider Name (Legal Business Name): JESSICA RANGEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 OLD DALTON ELLIJAY RD
CHATSWORTH GA
30705-2029
US

IV. Provider business mailing address

3656 HIGHWAY 52A
CHATSWORTH GA
30705-7706
US

V. Phone/Fax

Practice location:
  • Phone: 706-695-4564
  • Fax:
Mailing address:
  • Phone: 706-934-5560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: