Provider Demographics
NPI:1013953215
Name:PIPER, JENNIFER D (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:D
Last Name:PIPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:DONNELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:404-256-4777
Mailing Address - Fax:404-256-5515
Practice Address - Street 1:3330 PRESTON RIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4509
Practice Address - Country:US
Practice Address - Phone:678-566-6995
Practice Address - Fax:678-566-0346
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA425426027MMedicaid
GA425426027JMedicaid
GA425426027KMedicaid
GA425426027LMedicaid
GACA9328OtherMEDICARE GROUP-DMERC
GA425426027MMedicaid
GA425426027LMedicaid