Individual
JENNIFER NICOLE GARRETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3825 MEDICAL PARK DR STE 301, AUSTELL, GA 30106-6818
(770) 874-0692
Mailing address
3825 MEDICAL PARK DR STE 301, AUSTELL, GA 30106-6818
(770) 874-0692
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
5543
GA
363AM0700X
Medical Physician Assistant
Primary
5543
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013157569
NPI
GA
01
—
5543
GA MEDICAL BOARD
GA
Enumeration date
02/24/2009
Last updated
07/30/2024
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