Provider Demographics
NPI:1881037091
Name:BYNUM, JENNIFER PORTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:PORTER
Last Name:BYNUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:PORTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3300 BUCKEYE RD STE 178
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-4232
Mailing Address - Country:US
Mailing Address - Phone:770-458-6101
Mailing Address - Fax:770-455-4008
Practice Address - Street 1:3300 BUCKEYE RD STE 178
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4232
Practice Address - Country:US
Practice Address - Phone:770-458-6101
Practice Address - Fax:770-455-4008
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81345207ZP0101X, 207ZP0102X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology