Healthcare Provider Details

I. General information

NPI: 1881435899
Provider Name (Legal Business Name): JENNA A NASH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 08/28/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 SNAPFINGER PARK DR STE 110
DECATUR GA
30035-4066
US

IV. Provider business mailing address

1007 WINDSOR GREEN DR
CANTON GA
30115-7109
US

V. Phone/Fax

Practice location:
  • Phone: 770-981-2211
  • Fax:
Mailing address:
  • Phone: 770-981-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12491
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: