Healthcare Provider Details

I. General information

NPI: 1992896880
Provider Name (Legal Business Name): RONALD M JENNINGS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7615 MOUNT ZION BLVD
JONESBORO GA
30236-7934
US

IV. Provider business mailing address

PO BOX 100286
GAINESVILLE FL
32610-0286
US

V. Phone/Fax

Practice location:
  • Phone: 770-985-4257
  • Fax: 770-985-4258
Mailing address:
  • Phone: 352-265-0535
  • Fax: 352-627-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number003014
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006915
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: