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General NPI Number Information
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NPI Number | 1700022613
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Entity Type | Individual
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Provider Name | AMBRE JAMARRA FOUGEROUSSE PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 3991 STONE MOUNTAIN HWY
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City | SNELLVILLE
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State | GA
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Zip | 30039-3929
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Country | US
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Telephone | 678-786-8677
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Fax |
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Provider Business Mailing Address
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Address Line | 218 PASADENA AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33707-1251
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Country | US
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Telephone | 941-961-3303
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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 | PA9106967
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5491
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License Number State | GA
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