MEDICARE: JESSICA D FELTS FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN-NP282755	GA

General Provider Information

NPI Number	:	1174456800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA D FELTS FNP-BC

Provider Business Mailing Address
First Line	:	6123 WAYBURN ST
Second Line	:
City	:	TUCKER
State	:	GA
Zip	:	30084-3782
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FERRY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342
Country	:	US
Telephone Number	:	404-851-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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