Active NPI
Wendy Kae Jetton, CSA
- Surgical Physician Assistant
- Marietta, GA
National Provider Identifier
1467640649
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- 1256
- Practice address
- 915 Randall CT NW
Marietta, GA 30064-4724 - Phone
- (770) 842-1907
- Fax
- (678) 214-5098
- NPI assigned
- Oct 12, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 1256 | GA | Primary |
Addresses
Primary practice location
915 Randall CT NW
Marietta, GA 30064-4724
Mailing address
915 Randall CT NW
Marietta, GA 30064-4724
Phone (770) 842-1907
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1256 | GA | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jett Surgical LLC | Surgical | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Surgical Physician Assistant
- Marietta, GA
- NPI 1417408964
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478995200000",
"number": "1467640649",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "915 RANDALL CT NW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300644724",
"telephone_number": "770-842-1907",
"fax_number": "678-214-5098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "915 RANDALL CT NW",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300644724",
"telephone_number": "770-842-1907",
"fax_number": "678-214-5098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JETTON",
"first_name": "WENDY",
"middle_name": "KAE",
"name_prefix": "Ms.",
"credential": "CSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-10-12",
"last_updated": "2016-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "GA",
"license": "1256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.