Healthcare Provider Details

I. General information

NPI: 1447321518
Provider Name (Legal Business Name): JESSICA LEE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LEE PA-C

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8600
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

2727 PACES FERRY RD SE STE 1-1100
ATLANTA GA
30339-6151
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6005
  • Fax: 757-388-6006
Mailing address:
  • Phone: 404-605-5699
  • Fax: 404-609-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number030123
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011912
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005749
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009341
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA064208
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: