Provider Demographics
NPI:1780772251
Name:MCDONALD, JENNIFER W (CNM, NP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CNM, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30118-0001
Mailing Address - Country:US
Mailing Address - Phone:678-839-6452
Mailing Address - Fax:
Practice Address - Street 1:1601 MAPLE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30118-0001
Practice Address - Country:US
Practice Address - Phone:678-839-6452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165060367A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ62978Medicare UPIN