Provider Demographics
NPI:1134343585
Name:GOTTSCHALK, JENNIFER CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:GOTTSCHALK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:CHRISTINE
Other - Last Name:GOTTSCHALK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:315 BURNT OAK COURT
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-849-5913
Mailing Address - Fax:
Practice Address - Street 1:315 BURNT OAK COURT
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-849-5913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA62991208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics