Individual
JENNIFER SUZANNE LACEY NUNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
178 HOSPITAL RD STE A, BLAIRSVILLE, GA 30512-3139
(706) 745-3671
(706) 481-2700
Mailing address
178 HOSPITAL RD STE A, BLAIRSVILLE, GA 30512-3139
(706) 745-3671
(706) 481-2700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
053008
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
187001
BLUE CROSS BLUE SHIELD
GA
05
—
643758213A
—
GA
05
—
89066J4
—
GA
Enumeration date
12/29/2005
Last updated
12/07/2023
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