Individual
MRS. JENNIFER STANFIELD PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1211 SHERWOOD PARK DR NE STE B, GAINESVILLE, GA 30501-3444
(770) 219-4840
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-02537
NC
363A00000X
Physician Assistant
Primary
6191
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003121389A
—
GA
05
—
1344PA
—
SC
Enumeration date
09/09/2010
Last updated
01/22/2021
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