Provider Demographics
NPI:1023600566
Name:ADAMS, JESSICA THELMA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:THELMA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 MINERAL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4282
Mailing Address - Country:US
Mailing Address - Phone:404-732-6439
Mailing Address - Fax:
Practice Address - Street 1:1904 WELLBORN RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-5438
Practice Address - Country:US
Practice Address - Phone:404-732-6439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health