Provider Demographics
NPI:1730118001
Name:PFEIFER, ANDREA JENKE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JENKE
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:ANDREA
Other - Middle Name:JEAN
Other - Last Name:JENKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:736 ROCKY BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-5600
Mailing Address - Country:US
Mailing Address - Phone:706-863-1768
Mailing Address - Fax:706-364-8503
Practice Address - Street 1:580 BLUERIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4556
Practice Address - Country:US
Practice Address - Phone:706-364-8501
Practice Address - Fax:706-364-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA49546207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000919432BMedicaid
GAH54050Medicare UPIN
GA08BBXHQMedicare ID - Type Unspecified