Provider Demographics
NPI:1154329613
Name:FOOTE, JENELLE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JENELLE
Middle Name:E
Last Name:FOOTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 PIEDMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4117
Mailing Address - Country:US
Mailing Address - Phone:404-881-0966
Mailing Address - Fax:404-881-0966
Practice Address - Street 1:1924 PIEDMONT RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-4117
Practice Address - Country:US
Practice Address - Phone:404-881-0966
Practice Address - Fax:404-881-0966
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034592208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
33BDBMHMedicare PIN