Provider Demographics
NPI:1366692717
Name:NATHAN-FORERO, JENNIFER EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:EILEEN
Last Name:NATHAN-FORERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1364 CLIFTON RD NE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:777 7TH ST NW
Practice Address - Street 2:APT 722
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-5707
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD0381112085R0202X
GA907852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology