Provider Demographics
NPI:1386821049
Name:LAW, JENNIE HONLOI (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:HONLOI
Last Name:LAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5695 RILEY TER
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 OLD MILTON PKWY STE A130
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4417
Practice Address - Country:US
Practice Address - Phone:770-664-8898
Practice Address - Fax:770-772-4377
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002869207R00000X
MN104956207RE0101X
MN53389207RE0101X
GA70313208M00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNP00940150OtherRAILROAD MEDICARE
MNP00940150OtherRAILROAD MEDICARE