Healthcare Provider Details

I. General information

NPI: 1215928239
Provider Name (Legal Business Name): JENNIFER L. TIRINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L. TIRINO MD

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 OLD MILTON PKWY STE A410
ALPHARETTA GA
30005-3761
US

IV. Provider business mailing address

3400A OLD MILTON PKWY STE 410
ALPHARETTA GA
30005-4438
US

V. Phone/Fax

Practice location:
  • Phone: 770-251-8742
  • Fax: 678-254-0618
Mailing address:
  • Phone: 770-225-1874
  • Fax: 678-254-0618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number69142
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: