Provider Demographics
NPI:1841579554
Name:AUSTIN, JENNIE E (DMD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:E
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DELK RD SE
Mailing Address - Street 2:SUITE 1450
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-5320
Mailing Address - Country:US
Mailing Address - Phone:678-502-5604
Mailing Address - Fax:
Practice Address - Street 1:2900 DELK RD SE
Practice Address - Street 2:SUITE 1450
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5320
Practice Address - Country:US
Practice Address - Phone:678-502-5604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist