Healthcare Provider Details

I. General information

NPI: 1316815830
Provider Name (Legal Business Name): JENNA KLENZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2540 WINDY HILL RD SE
MARIETTA GA
30067-8605
US

IV. Provider business mailing address

2540 WINDY HILL RD SE
MARIETTA GA
30067-8605
US

V. Phone/Fax

Practice location:
  • Phone: 470-644-1274
  • Fax: 470-644-1119
Mailing address:
  • Phone: 470-644-1274
  • Fax: 470-644-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number13453
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13453
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: