Individual
JENNIFER SUE DE LA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2701 N. DECATUR ROAD, DECATUR, GA 30033
(404) 501-1849
Mailing address
1990 LAKESIDE PKWY, STE 170, TUCKER, GA 30084-5884
(770) 938-1757
(770) 938-1759
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003777
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424463934B
—
GA
05
—
424463934C
—
GA
Enumeration date
06/20/2006
Last updated
06/09/2021
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