Provider Demographics
NPI:1720136476
Name:JAHR, MARY B (CPNP-PC, PMHS-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:JAHR
Suffix:
Gender:F
Credentials:CPNP-PC, PMHS-BC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:HAMMOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC, PMHS-BC
Mailing Address - Street 1:3911 MARY ELIZA TRCE NW STE 500
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1089
Mailing Address - Country:US
Mailing Address - Phone:678-384-3480
Mailing Address - Fax:678-384-3481
Practice Address - Street 1:3911 MARY ELIZA TRCE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1086
Practice Address - Country:US
Practice Address - Phone:678-384-3480
Practice Address - Fax:678-384-3481
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA138345363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00978436DMedicaid