Basic Information
Provider Information
NPI: 1841571643
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AMERSON
FirstName: JESSICA
MiddleName: BATSON
NamePrefix: MRS.
NameSuffix:  
Credential: PA-A
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: BATSON
OtherFirstName: JESSICA
OtherMiddleName: M
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential: PA-A
OtherLastNameType: 1
Mailing Information
Address1: 531 ROSELANE ST NW
Address2: SUITE 750
City: MARIETTA
State: GA
PostalCode: 300606913
CountryCode: US
TelephoneNumber: 7707940477
FaxNumber: 7707943108
Practice Location
Address1: 531 ROSELANE ST NW
Address2: SUITE 750
City: MARIETTA
State: GA
PostalCode: 30060
CountryCode: US
TelephoneNumber: 7707940477
FaxNumber: 7707943108
Other Information
ProviderEnumerationDate: 09/07/2011
LastUpdateDate: 08/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367H00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant 

No ID Information.


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