Healthcare Provider Details

I. General information

NPI: 1487088670
Provider Name (Legal Business Name): JENNIFER E HIRSCH RN, BSN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2013
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 PALOMINO DR
NEWNAN GA
30265-1410
US

IV. Provider business mailing address

35 PALOMINO DR
NEWNAN GA
30265-1410
US

V. Phone/Fax

Practice location:
  • Phone: 904-307-9609
  • Fax:
Mailing address:
  • Phone: 904-307-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN289938
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: