Provider Demographics
NPI:1235837949
Name:JENNINGS, DANTE LAMAR
Entity Type:Individual
Prefix:
First Name:DANTE
Middle Name:LAMAR
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 TAVISTOCK CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8967
Mailing Address - Country:US
Mailing Address - Phone:678-960-8192
Mailing Address - Fax:
Practice Address - Street 1:416 TAVISTOCK CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-8967
Practice Address - Country:US
Practice Address - Phone:678-960-8192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care