Individual
DR. JENNIFER IRENE DIVERSI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
125 EAGLES POINTE PARKWAY, STE 110, STOCKBRIDGE, GA 30281
(770) 507-6100
(770) 507-5988
Mailing address
125 EAGLES POINTE PARKWAY, STE 110, STOCKBRIDGE, GA 30281
(770) 507-6100
(770) 507-5988
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
010539
GA
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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