Individual
MICHELAE JENNINGS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
403 PERMIAN WAY, VILLA RICA, GA 30180-3226
(323) 947-8494
Mailing address
2104 ROYAL FOX WAY, DECATUR, GA 30032-6145
(323) 947-8494
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
258064
GA
Other
Enumeration date
05/05/2021
Last updated
05/28/2026
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