Jessica Nicole Mathis, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN164716 Issued in GA

Practice address

132 Old Norton Rd
Suite 200
Fayetteville, GA 30215-4872

Phone

(678) 817-1117

Fax

(678) 817-0823

NPI assigned

Jun 24, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Northside Imaging LLC

  • Diagnostic Radiology Physician
  • Warner Robins, GA
  • NPI 1316394976
  NPD (past)
• NSH Cancer Institute Professional Services G, LLC

  • Hematology & Oncology Physician
  • Atlanta, GA
  • NPI 1124379284
  NPD (past)

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

{
    "created_epoch": "1435104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597795200000",
    "number": "1235511338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 SAVOY DR",
            "address_2": "SUITE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303411072",
            "telephone_number": "678-817-1117",
            "fax_number": "678-817-0823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 OLD NORTON RD",
            "address_2": "SUITE 200",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302154872",
            "telephone_number": "678-817-1117",
            "fax_number": "678-817-0823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHIS",
        "first_name": "JESSICA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-24",
        "last_updated": "2020-08-19",
        "certification_date": "2020-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN164716",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN164716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003169046B",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica.mathis.p1@direct.gacancer.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Direct Edge",
            "address_1": "132 Old Norton Rd",
            "address_2": "Suite 200",
            "city": "Fayetteville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302154872",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joanne Masanotti
• Sharon Joy Mascoe-Maxwell, RD., LD.
• Jarrett Evan Mask
• Massage Therapeutics, Inc Center for Wellness
• Deanna Mathis, RBT
• Rashunda Mathis, RBT
• Matter of Focus Counseling LLC
• Catherine Aubrey Mauney, A-GNP
• Danielle Mauzy, CERTIFIED DOULA, CPT
• Valerie Maxey, LCSW

• Nurse Practitioner in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.