Healthcare Provider Details

I. General information

NPI: 1699939710
Provider Name (Legal Business Name): JENNIFER HOLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 COMER AVE
COLUMBUS GA
31904-8725
US

IV. Provider business mailing address

5358 WOODRUFF FARM RD APT. 211
COLUMBUS GA
31907-1317
US

V. Phone/Fax

Practice location:
  • Phone: 706-596-5883
  • Fax:
Mailing address:
  • Phone: 706-505-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: