Provider Demographics
NPI:1447321518
Name:LEE, JESSICA DAWN (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:LEE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 1-1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6151
Mailing Address - Country:US
Mailing Address - Phone:404-605-5699
Mailing Address - Fax:404-609-7514
Practice Address - Street 1:95 COLLIER RD NW STE 5015
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1721
Practice Address - Country:US
Practice Address - Phone:404-605-5699
Practice Address - Fax:404-609-7514
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064208363A00000X
GA005749363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003130119KMedicaid
AKQ74225Medicare UPIN
AKK150599Medicare PIN
AK160958Medicare PIN