Provider Demographics
NPI:1194886036
Name:COUSINS, JENNIFER MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:COUSINS
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1093 GREENSBORO RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9505
Mailing Address - Country:US
Mailing Address - Phone:706-484-2121
Mailing Address - Fax:706-484-2148
Practice Address - Street 1:1093 GREENSBORO RD
Practice Address - Street 2:SUITE 108
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9505
Practice Address - Country:US
Practice Address - Phone:706-484-2121
Practice Address - Fax:706-484-2148
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA002288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist