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General NPI Number Information
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NPI Number | 1285302513
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Entity Type | Individual
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Provider Name | JESSICA ERICSON NP
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Gender | Female
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Dates
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Enumeration Date | 09/01/2021
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Last Update Date | 09/01/2021
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Provider Practice Location Address
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Address Line | 1364 CLIFTON RD NE STE D219
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City | ATLANTA
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State | GA
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Zip | 30322-1059
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Country | US
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Telephone | 404-712-2093
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Fax | 404-686-7076
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Provider Business Mailing Address
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Address Line | 620 GLEN IRIS DR NE UNIT 407
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City | ATLANTA
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State | GA
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Zip | 30308-2770
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Country | US
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Telephone | 404-290-4756
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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 | 363LX0106X
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Taxonomy Name | Occupational Health Nurse Practitioner
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License Number | RN159498
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License Number State | GA
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