MEDICARE: REBECCA JO KLEMSZ PA

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	363A00000X	Physician Assistant	9461	GA
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1194374991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA JO KLEMSZ PA

Provider Business Mailing Address
First Line	:	5447 DIVIDEND DR
Second Line	:
City	:	LITHONIA
State	:	GA
Zip	:	30058-8412
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W SPRING ST STE B220
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-3215
Country	:	US
Telephone Number	:	770-267-1895
Fax Number	:

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

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	12/10/2025

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