Provider Demographics
NPI:1235102955
Name:GATHANY, JENINE GHANI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENINE
Middle Name:GHANI
Last Name:GATHANY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENINE
Other - Middle Name:MELISSA
Other - Last Name:GHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:980 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 940
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1626
Mailing Address - Country:US
Mailing Address - Phone:404-851-8000
Mailing Address - Fax:404-252-2736
Practice Address - Street 1:980 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 940
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1626
Practice Address - Country:US
Practice Address - Phone:404-851-8000
Practice Address - Fax:404-252-2736
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004716363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA158543044AMedicaid
GAQ64188Medicare UPIN
GA97WCHHSMedicare ID - Type UnspecifiedMARIETTA