Healthcare Provider Details

I. General information

NPI: 1841651213
Provider Name (Legal Business Name): JESSICA OGBURN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 HOSPITAL DR #200
MACON GA
31217-3899
US

IV. Provider business mailing address

330 HOSPITAL DR #200
MACON GA
31217-3899
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-1191
  • Fax:
Mailing address:
  • Phone: 478-745-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN155771
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: