Healthcare Provider Details

I. General information

NPI: 1104264183
Provider Name (Legal Business Name): JESSICA JE'NAE THOMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA JE'NAE MILLER NP

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 COBB PKWY SE SUITE 60
MARIETTA GA
30060
US

IV. Provider business mailing address

1 EMBARCADERO CTR FL 19
SAN FRANCISCO CA
94111-3628
US

V. Phone/Fax

Practice location:
  • Phone: 678-820-7373
  • Fax: 415-252-7176
Mailing address:
  • Phone: 415-658-6791
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN828608
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN206683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: