Provider Demographics
NPI:1104926575
Name:TINKEY, JENNIFER LYNETTE (AUD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNETTE
Last Name:TINKEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNETTE
Other - Last Name:MCCLELLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:1260 HIGHWAY 54 W
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4514
Mailing Address - Country:US
Mailing Address - Phone:770-631-1833
Mailing Address - Fax:770-461-9402
Practice Address - Street 1:25 BULLSBORO DR
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1570
Practice Address - Country:US
Practice Address - Phone:770-251-2927
Practice Address - Fax:770-251-2995
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003991231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL085674600Medicaid
FL085674600Medicaid