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NPI Code Detail

MEDICARE: MRS. JESSICA QUYEN LUONG PA

MEDICARE:  MRS. JESSICA QUYEN LUONG  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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1609650118
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA QUYEN LUONG PA
Provider Business Mailing Address
First Line : 355 GRANDIFLORA DR
Second Line :
City : MCDONOUGH
State : GA
Zip : 30253-8010
Country : US
Telephone Number : 318-828-6054
Fax Number :
Provider Business Practice Location Address
First Line : 2909 BROOK OAK TRCE
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-6534
Country : US
Telephone Number : 318-828-6054
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2023
Last Update Date : 01/11/2025

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Directions to “ MRS. JESSICA QUYEN LUONG PA” Practice Location

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