Provider Demographics
NPI:1215976949
Name:GOTTSMAN, JENNIFER W (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:W
Last Name:GOTTSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JEAN
Other - Last Name:WILLERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1485 JESSE JEWELL PKWY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3806
Mailing Address - Country:US
Mailing Address - Phone:770-534-5255
Mailing Address - Fax:770-287-3871
Practice Address - Street 1:1485 JESSE JEWELL PKWY NE
Practice Address - Street 2:SUITE 200
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3806
Practice Address - Country:US
Practice Address - Phone:770-534-5255
Practice Address - Fax:770-287-3871
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00903152AMedicaid
GA000903152BMedicaid