Provider Demographics
NPI:1114210325
Name:STEPP, JESSICA (DO)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:STEPP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 W MEMORIAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132
Mailing Address - Country:US
Mailing Address - Phone:943-202-7870
Mailing Address - Fax:470-986-7205
Practice Address - Street 1:602 W MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132
Practice Address - Country:US
Practice Address - Phone:943-202-7870
Practice Address - Fax:470-986-7205
Is Sole Proprietor?:No
Enumeration Date:2011-05-20
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003133481GMedicaid
GA003133481GMedicaid