Provider Demographics
NPI:1336334739
Name:HEADRICK, JENNIFER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:HEADRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:RIDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:833 CAMPBELL HILL ST NW STE 250
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1162
Mailing Address - Country:US
Mailing Address - Phone:470-956-2020
Mailing Address - Fax:470-956-2030
Practice Address - Street 1:833 CAMPBELL HILL ST NW STE 250
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1162
Practice Address - Country:US
Practice Address - Phone:470-956-2020
Practice Address - Fax:470-956-2030
Is Sole Proprietor?:No
Enumeration Date:2007-09-09
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78716207R00000X
TXP9587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine