Individual
MIRIAM JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2763 TOBACCO RD STE E-2, HEPHZIBAH, GA 30815-7050
(706) 726-5406
Mailing address
2714 DEEN AVE, AUGUSTA, GA 30906-3232
(706) 726-5406
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CO104681
GA
Other
Enumeration date
08/22/2022
Last updated
08/22/2022
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