Provider Demographics
NPI:1578715421
Name:HANLON, JENNIFER LYNN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:HANLON
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 1:141 PIEDMONT AVE NE STE D
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2417
Mailing Address - Country:US
Mailing Address - Phone:404-413-1944
Mailing Address - Fax:404-413-1953
Practice Address - Street 1:141 PIEDMONT AVE NE STE D
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2417
Practice Address - Country:US
Practice Address - Phone:404-413-1944
Practice Address - Fax:404-413-1953
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2274363A00000X
CA20465363A00000X
GA7589363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1578715421OtherSTUDENT HEALH