Provider Demographics
NPI:1396947099
Name:MAZZAWI, JENNIFER MEGAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MEGAN
Last Name:MAZZAWI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-0365
Mailing Address - Country:US
Mailing Address - Phone:770-972-4436
Mailing Address - Fax:
Practice Address - Street 1:2317 PINE HEIGHTS DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-2835
Practice Address - Country:US
Practice Address - Phone:404-317-9044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0135461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice