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General NPI Number Information
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NPI Number | 1609650118
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Entity Type | Individual
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Provider Name | JESSICA QUYEN LUONG PA
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Gender | Female
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Dates
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Enumeration Date | 08/24/2023
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 2909 BROOK OAK TRCE
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City | SNELLVILLE
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State | GA
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Zip | 30078-6534
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Country | US
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Telephone | 318-828-6054
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Fax |
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Provider Business Mailing Address
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Address Line | 355 GRANDIFLORA DR
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City | MCDONOUGH
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State | GA
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Zip | 30253-8010
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Country | US
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Telephone | 318-828-6054
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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