Provider Demographics
NPI:1164720090
Name:DAWE, JENNIFER JORDAN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JORDAN
Last Name:DAWE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:770-942-0457
Mailing Address - Fax:770-942-7699
Practice Address - Street 1:4586 TIMBER RIDGE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7517
Practice Address - Country:US
Practice Address - Phone:770-942-0457
Practice Address - Fax:770-942-7699
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN171108363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003108710DMedicaid
GA003108710EMedicaid
GA20250I2087Medicare PIN