Individual
DR. JENNIFER C MCKENNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
109 PROFESSIONAL PL, CARROLLTON, GA 30117-3862
(770) 834-0170
(770) 214-1546
Mailing address
3 GLEN COVE DR, STE 1, ROCKPORT, ME 04856-4232
(770) 834-0170
(770) 214-1546
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD18326
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000797288C
PEACH STATE
GA
05
—
000797288C
—
GA
01
—
002047
BLUE CROSS BLUE SHIELD
GA
01
—
332133
WELLCARE
GA
01
—
581456616
TAX ID
GA
Enumeration date
11/01/2006
Last updated
02/17/2017
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