Provider Demographics
NPI:1356456685
Name:WOOTTEN, JENNIFER PITRA (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PITRA
Last Name:WOOTTEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:THE EMORY CLINIC DEPT OF PSYCHIATRY
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-778-5526
Mailing Address - Fax:404-778-4655
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:THE EMORY CLINIC DEPT OF PSYCHIATRY
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-5526
Practice Address - Fax:404-778-4655
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2008-01-09
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Provider Licenses
StateLicense IDTaxonomies
GA0357912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF88803Medicare UPIN
GA26BDFSZMedicare PIN
GA26BDFTKMedicare PIN