Provider Demographics
NPI:1427683424
Name:CORTES, JENISSA DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:JENISSA
Middle Name:DAWN
Last Name:CORTES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENISSA
Other - Middle Name:DAWN
Other - Last Name:GORDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, PA-C
Mailing Address - Street 1:5285 HOPGOOD RD
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-2427
Mailing Address - Country:US
Mailing Address - Phone:912-577-8510
Mailing Address - Fax:
Practice Address - Street 1:1400 TULLIE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2309
Practice Address - Country:US
Practice Address - Phone:404-785-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered