Healthcare Provider Details

I. General information

NPI: 1508396755
Provider Name (Legal Business Name): JESSICA FUENTES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 UNIVERSITY AVE
COLUMBUS GA
31907-5679
US

IV. Provider business mailing address

9499 FOREST CROWN DR
FORTSON GA
31808-6965
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-8620
  • Fax: 706-568-2323
Mailing address:
  • Phone: 706-992-3311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN205535
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: