Provider Demographics
NPI:1811195837
Name:JACOBS, JENNIFER E (DPM)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:E
Last Name:JACOBS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 LANGFORD DR. 400-102
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7370
Mailing Address - Country:US
Mailing Address - Phone:706-425-5433
Mailing Address - Fax:770-573-6764
Practice Address - Street 1:1747 LANGFORD DR BLDG 400-102
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7370
Practice Address - Country:US
Practice Address - Phone:706-425-5433
Practice Address - Fax:770-573-6764
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001149213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G707770Medicare PIN