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General NPI Number Information
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NPI Number | 1689491011
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Entity Type | Individual
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Provider Name | JESSICA JULIEN
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Gender | Female
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Dates
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Enumeration Date | 09/25/2024
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 193 E PIKE ST STE B
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5019
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Country | US
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Telephone | 678-915-9395
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Fax |
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Provider Business Mailing Address
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Address Line | 725 ROSE BROOKE DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-5411
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Country | US
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Telephone | 404-759-8476
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | ES008435
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License Number State | GA
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