Provider Demographics
NPI:1467787655
Name:THAN, JENNY H (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:H
Last Name:THAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2052 HOSEA L WILLIAMS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2502
Mailing Address - Country:US
Mailing Address - Phone:404-607-1002
Mailing Address - Fax:404-607-1031
Practice Address - Street 1:2052 HOSEA L WILLIAMS DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2502
Practice Address - Country:US
Practice Address - Phone:404-607-1002
Practice Address - Fax:404-607-1031
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA5594363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant