Healthcare Provider Details

I. General information

NPI: 1639748676
Provider Name (Legal Business Name): SAMANTHA ROSE JESSING YIP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3692 HIGHLANDS PKWY SE
SMYRNA GA
30082-5184
US

IV. Provider business mailing address

3692 HIGHLANDS PKWY SE
SMYRNA GA
30082-5184
US

V. Phone/Fax

Practice location:
  • Phone: 770-431-2322
  • Fax:
Mailing address:
  • Phone: 770-431-2322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN265370
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: