Provider Demographics
NPI:1992059505
Name:MCDONALD, JENNA NABORS (CPNP)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:NABORS
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEAH
Other - Last Name:NABORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:9280 HIGHWAY 5
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1501
Mailing Address - Country:US
Mailing Address - Phone:205-281-6655
Mailing Address - Fax:
Practice Address - Street 1:9280 HIGHWAY 5
Practice Address - Street 2:SUITE A
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1501
Practice Address - Country:US
Practice Address - Phone:770-942-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226556363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics