Healthcare Provider Details

I. General information

NPI: 1902671555
Provider Name (Legal Business Name): JENNIFER G BICKERSTAFF CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 N POINT PKWY STE 207
ALPHARETTA GA
30005-4381
US

IV. Provider business mailing address

3180 N POINT PKWY STE 207
ALPHARETTA GA
30005-4381
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-8725
  • Fax:
Mailing address:
  • Phone: 770-559-8725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number153680
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: