Healthcare Provider Details

I. General information

NPI: 1285451682
Provider Name (Legal Business Name): JESSICA L ADAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 MEMORIAL DR STE 201
DALTON GA
30720-8662
US

IV. Provider business mailing address

136 BATTLEFIELD CROSSING CT
RINGGOLD GA
30736-5176
US

V. Phone/Fax

Practice location:
  • Phone: 706-277-7311
  • Fax: 706-272-3512
Mailing address:
  • Phone: 706-277-7311
  • Fax: 706-529-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number37201
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP002763
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: