Basic Information
| Provider Information | |||||||||
| NPI: | 1497767131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCABE | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6325 HOSPITAL PKWY | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300975775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707124616 | ||||||||
| FaxNumber: | 7704951585 | ||||||||
| Practice Location | |||||||||
| Address1: | 6325 HOSPITAL PKWY | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | JOHNS CREEK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300975775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707124616 | ||||||||
| FaxNumber: | 7704951585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2006 | ||||||||
| LastUpdateDate: | 08/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 200200737 | NC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 061494 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 89132G | 05 | NC | MEDICAID |