Provider Demographics
NPI:1720067093
Name:SNOWDEN, JENNIFER BOSWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BOSWELL
Last Name:SNOWDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:YANCEY
Other - Last Name:BOSWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1117 PERIMETER CTR
Mailing Address - Street 2:N404
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5451
Mailing Address - Country:US
Mailing Address - Phone:770-817-4117
Mailing Address - Fax:
Practice Address - Street 1:1117 PERIMETER CTR
Practice Address - Street 2:N404
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5451
Practice Address - Country:US
Practice Address - Phone:770-817-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0430032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDHFVMedicare ID - Type Unspecified
GAH18225Medicare UPIN