Provider Demographics
NPI:1154870814
Name:CONKLIN, JESSICA PAN (PHD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PAN
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JIE
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2620 TALLEY ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4125
Mailing Address - Country:US
Mailing Address - Phone:617-230-1167
Mailing Address - Fax:
Practice Address - Street 1:3500 PIEDMONT RD NE STE 740
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1507
Practice Address - Country:US
Practice Address - Phone:404-875-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist