Healthcare Provider Details

I. General information

NPI: 1134240484
Provider Name (Legal Business Name): JENNIFER MAE HOOTMAN PHD, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 WINDWARD DR NW
KENNESAW GA
30152-4668
US

IV. Provider business mailing address

3004 WINDWARD DR NW
KENNESAW GA
30152-4668
US

V. Phone/Fax

Practice location:
  • Phone: 770-488-6038
  • Fax: 770-488-5486
Mailing address:
  • Phone: 770-488-6038
  • Fax: 770-488-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: