Provider Demographics
NPI:1346377611
Name:KEITH, JENNIFER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KEITH
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KEITH
Other - Last Name:BOONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:3434 WOODSHIRE XING
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-8720
Mailing Address - Country:US
Mailing Address - Phone:404-274-0387
Mailing Address - Fax:
Practice Address - Street 1:3535 ROSWELL RD STE 63
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8828
Practice Address - Country:US
Practice Address - Phone:404-585-4940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002996103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling