Provider Demographics
NPI:1013656354
Name:TONG, JENNA (CNM)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:TONG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 VARIATIONS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1009
Mailing Address - Country:US
Mailing Address - Phone:310-387-2135
Mailing Address - Fax:
Practice Address - Street 1:2685 PEACHTREE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1048
Practice Address - Country:US
Practice Address - Phone:770-771-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACNM07804367A00000X
GARN298050367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty