Provider Demographics
NPI:1124010863
Name:PRICE, JENNIFER S (DPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:PRICE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 UPPER HEMBREE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0929
Mailing Address - Country:US
Mailing Address - Phone:678-426-2171
Mailing Address - Fax:404-446-1957
Practice Address - Street 1:8855 HOSPITAL DR.
Practice Address - Street 2:STE. 150
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2267
Practice Address - Country:US
Practice Address - Phone:678-838-4443
Practice Address - Fax:678-838-4083
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000991213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA043309952MMedicaid
GA48SCCRJMedicare PIN
GA1103400016Medicare NSC
GA043309952MMedicaid
GAP00216505Medicare PIN