Provider Demographics
NPI:1134363583
Name:CIERNY, JILL TANENBAUM (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:TANENBAUM
Last Name:CIERNY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:RACHEL
Other - Last Name:TANENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-8035
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:1100 JOHNSON FY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1709
Practice Address - Country:US
Practice Address - Phone:404-252-1137
Practice Address - Fax:404-252-6794
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN49907207V00000X
GA071671207V00000X
SCLL31889207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3569OtherMEDICARE
GA300034164AMedicaid