=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104264183
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA JE'NAE THOMAS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2013
-----------------------------------------------------
Last Update Date | 07/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 COBB PKWY SE SUITE 60
-----------------------------------------------------
City | MARIETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-820-7373
-----------------------------------------------------
Fax | 415-252-7176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 EMBARCADERO CTR FL 19
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94111-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-658-6791
-----------------------------------------------------
Fax | 415-252-7176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | RN828608
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN206683
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------