Provider Demographics
NPI:1710037502
Name:GOOD, JENNIFER LYNN (DC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:GOOD
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:PO BOX 49188
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30359-1188
Mailing Address - Country:US
Mailing Address - Phone:404-844-0101
Mailing Address - Fax:
Practice Address - Street 1:3365 PIEDMONT RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1794
Practice Address - Country:US
Practice Address - Phone:404-844-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2021-10-25
Deactivation Date:2021-08-05
Deactivation Code:
Reactivation Date:2021-10-25
Provider Licenses
StateLicense IDTaxonomies
NYX010096111N00000X
GACHIR006805111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7S141Medicare ID - Type Unspecified