Provider Demographics
NPI:1740487131
Name:BROMLEY, JENNIFER GOODRICH (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GOODRICH
Last Name:BROMLEY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-8543
Mailing Address - Country:US
Mailing Address - Phone:912-354-4800
Mailing Address - Fax:912-269-5821
Practice Address - Street 1:4720 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6292
Practice Address - Country:US
Practice Address - Phone:912-354-4800
Practice Address - Fax:912-269-5821
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64514207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109549FMedicaid
GA202I183689OtherPTAN