Provider Demographics
NPI:1386136539
Name:PESL, JAIME ELAINE (NP-C)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ELAINE
Last Name:PESL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2530
Mailing Address - Country:US
Mailing Address - Phone:706-226-8950
Mailing Address - Fax:706-272-6836
Practice Address - Street 1:1215 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2530
Practice Address - Country:US
Practice Address - Phone:706-226-8950
Practice Address - Fax:706-272-6836
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner