=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861687063
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA VEANN SWILLEY NURSE PRACTITIONER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2007
-----------------------------------------------------
Last Update Date | 02/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1270 PRINCE AVENUE SUITE 308
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-552-1600
-----------------------------------------------------
Fax | 706-552-5370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1270 PRINCE AVE STE 308 ATHENS HEALTHCARE FOR WOMEN PC
-----------------------------------------------------
City | ATHENS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30606-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-552-1600
-----------------------------------------------------
Fax | 706-552-5370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LX0001X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
-----------------------------------------------------
License Number | R7170870
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------