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General NPI Number Information
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NPI Number | 1619327624
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Entity Type | Individual
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Provider Name | JESSIE CHU D.M.D
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Gender | Female
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Dates
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Enumeration Date | 06/21/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 849 SHUGART RD
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City | DALTON
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State | GA
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Zip | 30720-2433
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Country | US
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Telephone | 888-974-6734
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Fax |
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Provider Business Mailing Address
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Address Line | 801 CHATTANOOGA AVE
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City | DALTON
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State | GA
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Zip | 30720-8884
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Country | US
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Telephone | 205-873-1295
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN015400
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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