Provider Demographics
NPI:1396864799
Name:DICKSTEIN, JENNIFER RUTH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:DICKSTEIN
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 1:1795 N HOLLY LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3552
Mailing Address - Country:US
Mailing Address - Phone:404-641-9587
Mailing Address - Fax:404-320-6355
Practice Address - Street 1:1795 N HOLLY LN NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3552
Practice Address - Country:US
Practice Address - Phone:404-641-9587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies