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:
Health care specialties
Specialty | Code | License # | 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 2 years ago |
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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1245985886 | NPPES |
Georgia | MEDICAID | 003269528D |
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