Healthcare Provider Details

I. General information

NPI: 1043465941
Provider Name (Legal Business Name): JENNIFER A BUTTON NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 UPPER GATE DR NE
ATLANTA GA
30322-1014
US

IV. Provider business mailing address

550 PEACHTREE ST NE CRAWFORD LONG HOSPITAL
ATLANTA GA
30308-2247
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-2400
  • Fax:
Mailing address:
  • Phone: 404-626-2694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN116775
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: