Basic Information
| Provider Information | |||||||||
| NPI: | 1699980508 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAUNAS | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | JENNINGS | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 JOHNSON FERRY RD NE | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044191165 | ||||||||
| FaxNumber: | 4044191164 | ||||||||
| Practice Location | |||||||||
| Address1: | 5670 PEACHTREE DUNWOODY RD NE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048512300 | ||||||||
| FaxNumber: | 4048512357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2007 | ||||||||
| LastUpdateDate: | 11/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 005045 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 512768891C | 05 | GA | MEDICAID | 512768891A | 05 | GA | MEDICAID | 512768891B | 05 | GA | MEDICAID |