1669531729 NPI number — MRS. JENNIFER MICHELE VARNADO SLP006625

Table of content: MRS. JENNIFER MICHELE VARNADO SLP006625 (NPI 1669531729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669531729 NPI number — MRS. JENNIFER MICHELE VARNADO SLP006625

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VARNADO
Provider First Name:
JENNIFER
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP006625
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOSCICKI
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
SA7372
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669531729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7170 DEVONHALL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNS CREEK
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30097-1898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-970-4583
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7170 DEVONHALL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30097-1898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-970-4583
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA 7372 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP006625 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 888295900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".