Provider Demographics
NPI:1285952291
Name:ORKIN, JENNIFER RUTH (DNAP, CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:ORKIN
Suffix:
Gender:F
Credentials:DNAP, CRNA
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:MARCILLIAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:103 DEARBORN ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-2207
Mailing Address - Country:US
Mailing Address - Phone:120-528-9300
Mailing Address - Fax:
Practice Address - Street 1:3672 MARATHON CIR STE 120
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6821
Practice Address - Country:US
Practice Address - Phone:678-945-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-111862163W00000X
GARN210419367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA226367733AMedicaid