Provider Demographics
NPI:1376798272
Name:BILLINGSLEY, JENNIFER LOUISE
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LOUISE
Last Name:BILLINGSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-5425
Mailing Address - Country:US
Mailing Address - Phone:770-977-8644
Mailing Address - Fax:770-971-7953
Practice Address - Street 1:1121 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 320
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-5425
Practice Address - Country:US
Practice Address - Phone:770-977-8644
Practice Address - Fax:770-971-7953
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant