Provider Demographics
NPI:1427220284
Name:MICHAEL, JENNIFER B
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:B
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BRISTLECONE BND SW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-7483
Mailing Address - Country:US
Mailing Address - Phone:770-315-3932
Mailing Address - Fax:
Practice Address - Street 1:125 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3507
Practice Address - Country:US
Practice Address - Phone:770-386-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist