Provider Demographics
NPI:1013157569
Name:GARRETT, JENNIFER NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICOLE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 311452
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31131-1452
Mailing Address - Country:US
Mailing Address - Phone:256-239-8336
Mailing Address - Fax:
Practice Address - Street 1:1250 UPPER HEMBREE RD STE B
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4651
Practice Address - Country:US
Practice Address - Phone:770-558-2873
Practice Address - Fax:888-832-7996
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5543OtherGA MEDICAL BOARD
GA1013157569OtherNPI