Provider Demographics
NPI:1215517248
Name:HEATH, JESSICA THAMES (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:THAMES
Last Name:HEATH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HIGHWAY 34 E STE B
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1325
Mailing Address - Country:US
Mailing Address - Phone:770-400-8400
Mailing Address - Fax:770-666-2461
Practice Address - Street 1:1615 HIGHWAY 34 E STE B
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1325
Practice Address - Country:US
Practice Address - Phone:770-400-8400
Practice Address - Fax:770-666-2461
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF02211261207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology