Provider Demographics
NPI:1518320019
Name:SHORT, JENNIFER (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SHORT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:69 JESSE HILL JR DR SE
Mailing Address - Street 2:GLENN MEMORIAL BUILDING, ROOM 302D
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3033
Mailing Address - Country:US
Mailing Address - Phone:404-251-8914
Mailing Address - Fax:404-523-3931
Practice Address - Street 1:69 JESSE HILL JR DR SE
Practice Address - Street 2:GLENN MEMORIAL BUILDING, ROOM 302D
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3033
Practice Address - Country:US
Practice Address - Phone:404-251-8914
Practice Address - Fax:404-523-3931
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA7935363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical