Provider Demographics
NPI:1760966535
Name:SANTOS, JENISE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENISE
Middle Name:MARIE
Last Name:SANTOS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:835 COGBURN AVENUE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1010
Mailing Address - Country:US
Mailing Address - Phone:770-422-8815
Mailing Address - Fax:770-422-8816
Practice Address - Street 1:1150 BROOKSTONE CENTRE PARKWAY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-4577
Practice Address - Country:US
Practice Address - Phone:706-257-4189
Practice Address - Fax:706-257-4194
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2023-10-25
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Provider Licenses
StateLicense IDTaxonomies
GA8952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant