1376798272 NPI number — MISS JENNIFER LOUISE BILLINGSLEY

Table of content: MISS JENNIFER LOUISE BILLINGSLEY (NPI 1376798272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376798272 NPI number — MISS JENNIFER LOUISE BILLINGSLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BILLINGSLEY
Provider First Name:
JENNIFER
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376798272
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1121 JOHNSON FERRY RD
Provider Second Line Business Mailing Address:
SUITE 320
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30068-5425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-977-8644
Provider Business Mailing Address Fax Number:
770-971-7953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 JOHNSON FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 320
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30068-5425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-977-8644
Provider Business Practice Location Address Fax Number:
770-971-7953
Provider Enumeration Date:
11/20/2008

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: 126800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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