Provider Demographics
NPI:1053043133
Name:BIRDSEYE, JANA
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:BIRDSEYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 KINGSTON CT SE STE 103
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8928
Mailing Address - Country:US
Mailing Address - Phone:770-644-0555
Mailing Address - Fax:770-644-0514
Practice Address - Street 1:2141 KINGSTON CT SE STE 103
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8928
Practice Address - Country:US
Practice Address - Phone:770-644-0555
Practice Address - Fax:770-644-0514
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN