Healthcare Provider Details

I. General information

NPI: 1245122449
Provider Name (Legal Business Name): JESSICA THIGPEN SMITH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 HIGH HILL ST
IRWINTON GA
31042-2611
US

IV. Provider business mailing address

2963 HURST RD
TENNILLE GA
31089-2149
US

V. Phone/Fax

Practice location:
  • Phone: 478-946-2226
  • Fax: 478-946-2220
Mailing address:
  • Phone: 478-232-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN176626
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: