Broth, Jessica

Broth, Jessica is an individual health care provider with primary practice located at 1506 Klondike Rd Sw Ste 205 , Conyers GA 30094-5173. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Lactation Consultant, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Broth, Jessica can be contacted via phone (678) 750-4000.

Contact Information

Primary practice address
1506 Klondike Rd Sw Ste 205 Conyers GA 30094-5173
Phone: (678) 750-4000
Fax: (678) 750-4005
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Lactation Consultant 163WL0100X LC000233 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X RN175180 Georgia

Profile Details

NPI number 1245985886
LBN Legal business name Broth, Jessica
Credentials FNP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 12th, 2022
Last updated Mar 1st, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245985886 NPPES
Georgia MEDICAID 003269528D

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