Provider Demographics
NPI:1376678920
Name:AZAR, JENNIFER (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:AZAR
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:113 FLYING SCOT CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4234
Mailing Address - Country:US
Mailing Address - Phone:770-601-1907
Mailing Address - Fax:888-502-0302
Practice Address - Street 1:755 MOUNT VERNON HWY NE STE 250
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4290
Practice Address - Country:US
Practice Address - Phone:404-348-4456
Practice Address - Fax:404-348-4495
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN140308363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE19515Medicare UPIN
GAH87353Medicare UPIN
GAE82418Medicare UPIN
GAS84575Medicare UPIN
GAI32998Medicare UPIN
GAQ03630Medicare UPIN