Provider Demographics
NPI:1265927230
Name:MILLSAP, JENNIFER ERIN (PHYSICIANS ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ERIN
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ERIN
Other - Last Name:SHAPIRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 BELLEVUE RD STE 21A
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2890
Mailing Address - Country:US
Mailing Address - Phone:478-328-0281
Mailing Address - Fax:478-328-0438
Practice Address - Street 1:415 E CROSSVILLE RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7626
Practice Address - Country:US
Practice Address - Phone:770-642-4644
Practice Address - Fax:478-328-0438
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8836363A00000X
GA7861207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant