Sissom, Jennifer B.

Sissom, Jennifer B. is an individual health care provider with primary practice located at 2383 Pate St N , Snellville GA 30078-3250. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Sissom, Jennifer B. can be contacted via phone (770) 972-4845.

Contact Information

Primary practice address
2383 Pate St N Snellville GA 30078-3250
Phone: (770) 972-4845
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 004267 Georgia

Profile Details

NPI number 1063488708
LBN Legal business name Sissom, Jennifer B.
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 23rd, 2006
Last updated Mar 17th, 2018 - about 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063488708 NPPES
Georgia MEDICAID 824570839A

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