Basic Information
Provider Information
NPI: 1508274119
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STROTHER
FirstName: JENNIFER
MiddleName: ANN
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: JONES
OtherFirstName: JENNIFER
OtherMiddleName: ANN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: NP
OtherLastNameType: 1
Mailing Information
Address1: 275 COLLIER RD NW
Address2: SUITE 300
City: ATLANTA
State: GA
PostalCode: 303091709
CountryCode: US
TelephoneNumber: 4046052800
FaxNumber:  
Practice Location
Address1: 275 COLLIER RD NW
Address2: SUITE 300
City: ATLANTA
State: GA
PostalCode: 30309
CountryCode: US
TelephoneNumber: 4046052800
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/28/2014
LastUpdateDate: 08/08/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200XRN193633GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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