Healthcare Provider Details

I. General information

NPI: 1851075410
Provider Name (Legal Business Name): JESSICA BARTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 SANDY PLAINS RD STE 203
MARIETTA GA
30066-4377
US

IV. Provider business mailing address

2827 CHAPMAN WAY
MARIETTA GA
30066-3674
US

V. Phone/Fax

Practice location:
  • Phone: 404-860-2949
  • Fax:
Mailing address:
  • Phone: 404-550-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2472E0500X
TaxonomyEEG Technician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: