Individual
JENNICE H. GIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
136 SOUTHGATE BLVD, MCDONOUGH, GA 30253-8035
(678) 289-6483
Mailing address
PO BOX 73709, NEWNAN, GA 30271-3709
(770) 251-2060
(678) 854-9235
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN134488
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
664068606B
—
GA
Enumeration date
02/09/2006
Last updated
06/17/2020
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