Healthcare Provider Details

I. General information

NPI: 1447352604
Provider Name (Legal Business Name): JESSICA DUREL MCCLUSKEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA DUREL TAYLOR

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 BARFIELD RD
SANDY SPRINGS GA
30328-4411
US

IV. Provider business mailing address

5901A PEACHTREE DUNWOODY RD NE STE 500
ATLANTA GA
30328-5382
US

V. Phone/Fax

Practice location:
  • Phone: 678-892-2020
  • Fax: 678-538-1972
Mailing address:
  • Phone: 678-892-2020
  • Fax: 678-538-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number60943
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberM4336
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number60943
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: