Provider Demographics
NPI:1699518050
Name:WELCH, JENNIFER ELIZABETH
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:WELCH
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 1:118 ALBANY ST
Mailing Address - Street 2:
Mailing Address - City:MORVEN
Mailing Address - State:GA
Mailing Address - Zip Code:31638-2339
Mailing Address - Country:US
Mailing Address - Phone:256-493-9551
Mailing Address - Fax:
Practice Address - Street 1:118 ALBANY ST
Practice Address - Street 2:
Practice Address - City:MORVEN
Practice Address - State:GA
Practice Address - Zip Code:31638-2339
Practice Address - Country:US
Practice Address - Phone:256-493-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals