JESSICA BRODERICK (NPI# 1700365103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700365103 |
| Entity Type | Individual |
| Full Name | JESSICA BRODERICK |
| Credential | PA-C |
| Practice Address |
1800 Northside Forsyth Dr Ste 450 Cumming GA 30041-8483 |
| Mailing Address |
Po Box 636 Pine Lake GA 30072-0636 |
| Practice Telephone | 7704421911 |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-08-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 8887 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538728225 | Jessica Lynn Broderick | Surgery | 5450 Fort St, Trenton, MI 48183-4601 | 2019-06-06 |
| 1881059038 | Jessica Broderick | Speech-Language Pathologist | 2027 10th St, Gering, NE 69341-2417 | 2015-12-15 |
| 1184091530 | Jessica Broderick | Counselor | 3415 Se Powell Blvd, Portland, OR 97202-3371 | 2015-09-01 |
| Street Address |
1800 NORTHSIDE FORSYTH DR STE 450 |
| City | CUMMING |
| State | GA |
| Zip Code | 30041-8483 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063828408 | Stephanie Evans Wellborn | Physician Assistant | 1800 Northside Forsyth Dr Ste 450, Cumming, GA 30041 | 2014-07-07 |
| 1871131086 | Abigail Leigh Wiseley | Physician Assistant | 1800 Northside Forsyth Dr Ste 450, Cumming, GA 30041-8483 | 2019-12-18 |
| 1023572849 | Sarah Elizabeth Balkcom | Physician Assistant | 1800 Northside Forsyth Dr Ste 450, Cumming, GA 30041-8483 | 2019-01-25 |
| 1497140750 | Ebimoboere Okoro | Family Medicine | 1800 Northside Forsyth Dr Ste 450, Cumming, GA 30041-8483 | 2015-04-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962036905 | Annie Kyungjin Han | Nurse Practitioner | 1505 Northside Forsyth Drive, Suite 2500, Cumming, GA 30041 | 2020-02-28 |
| 1295388197 | Pamela Edler | Pharmacist | 1200 Northside Forsyth Drive, Pharmacy Department, Cumming, GA 30041 | 2019-07-19 |
| 1720557127 | Dr. Tiffany Lamonde LLC | Physical Therapist | 1445 Haw Creek Circle, Suite 503, Cumming, GA 30041 | 2018-11-15 |
| 1487140893 | Bhbd LLC | Chiropractor | 425 Peachtree Parkway, Suite 315, Cumming, GA 30041 | 2018-07-09 |
| 1891219861 | Anna Gawrys | Pharmacist | 1525 Marketplace Blvd, Cumming, GA 30041 | 2017-08-01 |
| 1679029219 | Square One Dental LLC | Clinic/Center | 3510 Rowe Lane, Cumming, GA 30041 | 2016-09-01 |
| 1720441454 | Pavilion Psychological Services LLC | Psychologist | 1445 Haw Creek Corners Circle East, Suite 501, Cumming, GA 30041 | 2016-03-31 |
| 1346606506 | American Health Imaging of Ga, LLC | Clinic/Center | 1050 Haw Creek Pkwy, Suite 100, Cumming, GA 30041 | 2016-01-04 |
| 1013311307 | Stephen Hartle | Physician Assistant | 2576 Peachtree Pkwy, Suite 100, Cumming, GA 30041 | 2014-10-15 |
| 1427462480 | Ly Le | Pharmacist | 2395 Peachtree Parkway, Cumming, GA 30041 | 2014-06-18 |
| Find all providers in zip 30041 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770105371 | Stetson Lee Carroll | Physician Assistant | 3955 Copper Leaf Ln, Cumming, GA 30040-4168 | 2020-05-18 |
| 1144865551 | William Phillip Whitlock | Physician Assistant | 6325 Oak Valley Dr, Cumming, GA 30040-6484 | 2019-11-08 |
| 1598320087 | Emily Rebecca Downs | Physician Assistant | 3970 Deputy Bill Cantrell Memorial Road Ste 150, Cumming, GA 30040 | 2019-05-09 |
| 1396206728 | Sydney Lane Kent | Physician Assistant | 4555 Azurite St, Cumming, GA 30040-0650 | 2019-03-28 |
| 1437697893 | Holly Musgrove | Physician Assistant | 1780 Peachtree Pkwy # 302, Cumming, GA 30041-6834 | 2017-02-06 |
| 1386938611 | Amanda Gilleland Appling | Physician Assistant | 3970 Deputy Bill Cantrell Memorial Rd., Ste 203, Cumming, GA 30040 | 2011-06-03 |
| 1578867040 | Holly Marie Shalhoop | Physician Assistant | 1800 Northside Forsyth Dr Ste 370, Cumming, GA 30041-8483 | 2010-12-27 |
| 1326358920 | Stephenie Wing Tsui | Physician Assistant | 1505 Northside Blvd Ste 2800, Cumming, GA 30041-8005 | 2010-10-15 |
| 1396997235 | Wanda G. Buchheit | Physician Assistant | 6825 Turning Leaf Ct, Cumming, GA 30028-4773 | 2008-10-22 |
| 1548395957 | Edward Harley Gaile Sr. | Physician Assistant | 1505 Northside Forsyth Dr, Ste 3600, Cumming, GA 30041 | 2007-02-23 |
| Find all providers in CUMMING | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.