Provider Demographics
NPI:1699451534
Name:JENNINGS, REINE (LDO)
Entity type:Individual
Prefix:
First Name:REINE
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 ZOIE LANE
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268
Mailing Address - Country:US
Mailing Address - Phone:404-910-2679
Mailing Address - Fax:
Practice Address - Street 1:551 ZOIE LANE
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268
Practice Address - Country:US
Practice Address - Phone:404-910-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002597156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician