Provider Demographics
NPI:1679167258
Name:FEBLES, JESSICA LYNDSEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNDSEY
Last Name:FEBLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3646 CHAMBLEE TUCKER RD
Mailing Address - Street 2:STE B
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4406
Mailing Address - Country:US
Mailing Address - Phone:678-849-4817
Mailing Address - Fax:
Practice Address - Street 1:3646 CHAMBLEE TUCKER RD UNIT B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:770-493-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-24
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA10446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program