Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 079324 | GA |
Y | 207Q00000X | Family Doctor | ME127657 | FL |
N | 207QA0401X | Family Doctor - Addiction Medicine | ME127657 | FL |
NPI | 1912249756 |
---|---|
Provider Name | Jessica Lynn Visser |
First Address | Canton, GA 30115-8015 |
Second Address | Canton, GA 30115-8015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2013 |
Last Update Date | 26/12/2018 |