Healthcare Provider Details

I. General information

NPI: 1316561608
Provider Name (Legal Business Name): TROY JENSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BATTLEFIELD PKWY
RINGGOLD GA
30736-5166
US

IV. Provider business mailing address

4700 BATTLEFIELD PKWY
RINGGOLD GA
30736-5166
US

V. Phone/Fax

Practice location:
  • Phone: 330-971-7000
  • Fax:
Mailing address:
  • Phone: 706-861-4990
  • Fax: 706-841-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58033138
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: