Healthcare Provider Details

I. General information

NPI: 1497049639
Provider Name (Legal Business Name): JENNIFER KOLOS LAMBERT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2011
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE #350
MARIETTA GA
30060-1155
US

IV. Provider business mailing address

55 WHITCHER ST NE #350
MARIETTA GA
30060-1155
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-6893
  • Fax:
Mailing address:
  • Phone: 770-424-6893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006847
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02922
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: