Provider Demographics
NPI:1831173418
Name:KIESEL, JARRETT R (PA)
Entity type:Individual
Prefix:
First Name:JARRETT
Middle Name:R
Last Name:KIESEL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:601 S ENOTA DR NE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2400
Mailing Address - Country:US
Mailing Address - Phone:770-219-6520
Mailing Address - Fax:770-219-6521
Practice Address - Street 1:1315 JESSE JEWELL PKWY NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3822
Practice Address - Country:US
Practice Address - Phone:770-219-6520
Practice Address - Fax:770-219-6521
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2012-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA003961363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP66420Medicare UPIN