Provider Demographics
NPI:1609334671
Name:WILLIAMS, JENNA (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 BROOKRIDGE TER
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-1681
Mailing Address - Country:US
Mailing Address - Phone:404-780-0681
Mailing Address - Fax:
Practice Address - Street 1:670 N MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2401
Practice Address - Country:US
Practice Address - Phone:404-780-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-07
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010160111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor