Provider Demographics
NPI:1740260256
Name:JENNINGS, JEFFREY LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEE
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7370 HODGSON MEMORIAL DR
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2536
Mailing Address - Country:US
Mailing Address - Phone:912-351-0168
Mailing Address - Fax:912-351-9159
Practice Address - Street 1:7370 HODGSON MEMORIAL DR
Practice Address - Street 2:SUITE B-3
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2536
Practice Address - Country:US
Practice Address - Phone:912-351-0168
Practice Address - Fax:912-351-9159
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA974103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00528426AMedicaid
GA68BBCJHMedicare ID - Type UnspecifiedGA MEDICARE PART B