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General NPI Number Information
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NPI Number | 1114705571
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Entity Type | Individual
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Provider Name | JENNIFER VILLEGAS PAC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 04/13/2025
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Provider Practice Location Address
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Address Line | 2200 MEDICAL CENTER BLVD STE 320
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7767
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Country | US
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Telephone | 470-325-1160
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Fax | 678-701-9860
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Provider Business Mailing Address
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Address Line | 2200 MEDICAL CENTER BLVD STE 320
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7767
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Country | US
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Telephone | 470-325-1160
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Fax | 678-701-9860
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13012
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License Number State | GA
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