Healthcare Provider Details

I. General information

NPI: 1720570211
Provider Name (Legal Business Name): JESSICA HENDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 MERCY BLVD
SAVANNAH GA
31419-1711
US

IV. Provider business mailing address

845 KELSALL DR
RICHMOND HILL GA
31324-7715
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-4100
  • Fax:
Mailing address:
  • Phone: 912-657-0891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number206895
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: