Provider Demographics
NPI:1447352604
Name:MCCLUSKEY, JESSICA DUREL (MD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:DUREL
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:DUREL
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5901A PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:STE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5382
Mailing Address - Country:US
Mailing Address - Phone:678-892-2020
Mailing Address - Fax:678-538-1972
Practice Address - Street 1:5995 BARFIELD RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4411
Practice Address - Country:US
Practice Address - Phone:678-892-2020
Practice Address - Fax:678-538-1972
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4336207W00000X
GA60943207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA438251418BMedicaid
GA438251418AMedicaid
GA438251418AMedicaid
GA438251418BMedicaid
GA511I180044Medicare PIN
GA1078920007Medicare NSC