Healthcare Provider Details

I. General information

NPI: 1720334931
Provider Name (Legal Business Name): JENIFER BYRD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 HARMONY XING STE 1
EATONTON GA
31024-9573
US

IV. Provider business mailing address

121 HARMONY XING STE 1
EATONTON GA
31024-9573
US

V. Phone/Fax

Practice location:
  • Phone: 762-220-1222
  • Fax: 877-569-2615
Mailing address:
  • Phone: 762-220-1222
  • Fax: 877-569-2615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN149798
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: