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General NPI Number Information
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NPI Number | 1427043983
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Entity Type | Individual
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Provider Name | JENNIFER TRICIA WILLIS CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 2608 CREST VALLEY DRIVE
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City | CONYERS
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State | GA
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Zip | 30094
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Country | US
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Telephone | 404-428-2237
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Fax | 404-428-2237
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Provider Business Mailing Address
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Address Line | 2608 CREST VALLEY DRIVE
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City | CONYERS
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State | GA
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Zip | 30094
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Country | US
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Telephone | 770-648-8237
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Fax | 770-648-8237
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 180459
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License Number State | GA
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