Provider Demographics
NPI:1104436872
Name:ZEHNA, JESSICA WOLFE (PA-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:WOLFE
Last Name:ZEHNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 MALABAR WAY
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3963
Mailing Address - Country:US
Mailing Address - Phone:706-206-1139
Mailing Address - Fax:
Practice Address - Street 1:220 HAWTHORNE PARK
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2148
Practice Address - Country:US
Practice Address - Phone:706-540-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1173288363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant