Individual
JENNIFER MARCELLINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
896 HIGHWAY 441 S, CLAYTON, GA 30525-5423
(706) 782-5991
Mailing address
PO BOX 459, COLBERT, GA 30628-0459
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003379
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0119PA
—
SC
05
—
177951430B
—
GA
Enumeration date
09/15/2006
Last updated
05/04/2022
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