Healthcare Provider Details

I. General information

NPI: 1649953902
Provider Name (Legal Business Name): JESSICA MORGAN BOATNER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1476 TURNER MCCALL BLVD SW
ROME GA
30161-6072
US

IV. Provider business mailing address

1476 TURNER MCCALL BLVD SW
ROME GA
30161-6072
US

V. Phone/Fax

Practice location:
  • Phone: 706-290-8043
  • Fax: 706-290-9731
Mailing address:
  • Phone: 706-290-8043
  • Fax: 706-290-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number034409
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: