Provider Demographics
NPI:1932879855
Name:OWEIDA, JENNA (CPNP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:OWEIDA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 PARKSIDE TRL NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4713
Mailing Address - Country:US
Mailing Address - Phone:404-680-1213
Mailing Address - Fax:
Practice Address - Street 1:2520 WINDY HILL RD SE STE 104
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8633
Practice Address - Country:US
Practice Address - Phone:678-501-5601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN243519363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty