Healthcare Provider Details

I. General information

NPI: 1245832971
Provider Name (Legal Business Name): JANELL J FENN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANELL FENN NP

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11555 MEDLOCK BRIDGE RD STE 100
JOHNS CREEK GA
30097-3200
US

IV. Provider business mailing address

PO BOX 8209
VIENNA VA
22183-2058
US

V. Phone/Fax

Practice location:
  • Phone: 251-901-3011
  • Fax: 251-901-3011
Mailing address:
  • Phone: 251-901-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN188392
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberRN188392
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: