Healthcare Provider Details

I. General information

NPI: 1013833433
Provider Name (Legal Business Name): JESSICA WILLIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5271 LAWRENCEVILLE HWY NW STE A
LILBURN GA
30047-5922
US

IV. Provider business mailing address

504 CADES CV
LAWRENCEVILLE GA
30045-6751
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-1616
  • Fax:
Mailing address:
  • Phone: 205-492-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP327579
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: