Provider Demographics
NPI:1780964668
Name:BROWN, JESSICA ROBERSON (PA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ROBERSON
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:PETRICE
Other - Last Name:ROBERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:298 US HIGHWAY 520
Mailing Address - Street 2:
Mailing Address - City:CUSSETA
Mailing Address - State:GA
Mailing Address - Zip Code:31805-3602
Mailing Address - Country:US
Mailing Address - Phone:706-989-1050
Mailing Address - Fax:706-989-1051
Practice Address - Street 1:298 US HIGHWAY 520
Practice Address - Street 2:
Practice Address - City:CUSSETA
Practice Address - State:GA
Practice Address - Zip Code:31805-3602
Practice Address - Country:US
Practice Address - Phone:706-989-1050
Practice Address - Fax:706-989-1051
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006173363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant