Healthcare Provider Details

I. General information

NPI: 1841580180
Provider Name (Legal Business Name): JENNIFER ANN GEORGIA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN GILBERT (MAIDENT) PA

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 HAGGERTY RD STE 1110
WEST BLOOMFIELD MI
48323
US

IV. Provider business mailing address

2300 HAGGERTY RD STE 1110
WEST BLOOMFIELD MI
48323
US

V. Phone/Fax

Practice location:
  • Phone: 248-669-2000
  • Fax: 248-669-2110
Mailing address:
  • Phone: 248-669-2000
  • Fax: 248-669-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5601007054
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601007054
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: