Individual provider Active NPI

Jessica Ann Nicoletti, NP

  • Family Nurse Practitioner
  • Roswell, GA
National Provider Identifier
1215542329
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN237694 Issued in GA
Practice address
1380 Woodstock Rd
Roswell, GA 30075-2141
Phone
(702) 308-8750
NPI assigned
Sep 15, 2020
Last updated
Sep 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN237694 GA Primary

Addresses

Primary practice location

1380 Woodstock Rd
Roswell, GA 30075-2141

Mailing address

1380 Woodstock Rd
Roswell, GA 30075-2141
Phone (770) 640-3131

Other practice location 1

207 Crestmont Way
Canton, GA 30114-8875
Phone (678) 880-6698

Other practice location 2

950 Towne Lake Pkwy
Woodstock, GA 30189-1601
Phone (404) 948-3019

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201130003055 GA Practitioner - Nurse Practitioner 2466863261 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Professional Services LLCGroup PAC ID 8921176231, 171 clinicians

Practice addresses (Care Compare)

950 Towne Lake Pkwy
Woodstock, GA 30189-1601
Phone (678) 732-1505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN237694GAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Piedmont Professional Services, LLC CurrentSince Sep 11, 2023 Accepting new patients
Piedmont Medical Care Corporation CurrentSince Oct 1, 2024 Accepting new patients

Locations

1762 Mars Hill Rd NW
Acworth, GA 30101
Phone (678) 732-1506

105 Collier Rd NW
Ste 5020
Atlanta, GA 30309
Phone (404) 350-3860

1267 Highway 54 W
Ste 2200
Fayetteville, GA 30214
Phone (470) 271-3415

551 N Cherokee Rd
Social Circle, GA 30025
Phone (678) 342-6000

950 Towne Lake Pkwy
Woodstock, GA 30189
Phone (678) 732-1505

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1600128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1215542329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 WOODSTOCK RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752141",
            "telephone_number": "770-640-3131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1380 WOODSTOCK RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300752141",
            "telephone_number": "702-308-8750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "207 Crestmont Way",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "GA",
            "postal_code": "301148875",
            "country_code": "US",
            "telephone_number": "678-880-6698",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "950 Towne Lake Pkwy",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "GA",
            "postal_code": "301891601",
            "country_code": "US",
            "telephone_number": "404-948-3019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NICOLETTI",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-15",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN237694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, GA

Sources for this page

Verify at the official NPI Registry.