Healthcare Provider Details

I. General information

NPI: 1578886941
Provider Name (Legal Business Name): JESSICA G KOSMOWSKI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA M GILBERT CRNA

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 3RD ST SUITE 206
MACON GA
31201-3294
US

IV. Provider business mailing address

101 PRINCETON DR
MACON GA
31220-8739
US

V. Phone/Fax

Practice location:
  • Phone: 478-464-2600
  • Fax:
Mailing address:
  • Phone: 478-737-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN170482
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: