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General NPI Number Information
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NPI Number | 1205445426
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Entity Type | Individual
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Provider Name | JESSICA NICOLE BREAUX NP
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Gender | Female
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Dates
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Enumeration Date | 07/23/2020
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 1267 HIGHWAY 54 W STE 2200
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-2110
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Country | US
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Telephone | 770-716-0051
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Fax |
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Provider Business Mailing Address
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Address Line | 195 COWETA LAKE RD
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City | NEWNAN
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State | GA
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Zip | 30265-1815
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Country | US
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Telephone | 404-226-4836
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN-NP239680
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN239680
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License Number State | GA
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