Healthcare Provider Details

I. General information

NPI: 1609650118
Provider Name (Legal Business Name): JESSICA QUYEN LUONG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 S 8TH ST
GRIFFIN GA
30224-4818
US

IV. Provider business mailing address

355 GRANDIFLORA DR
MCDONOUGH GA
30253-8010
US

V. Phone/Fax

Practice location:
  • Phone: 770-460-8988
  • Fax: 770-460-0727
Mailing address:
  • Phone: 318-828-6054
  • 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: