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General NPI Number Information
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NPI Number | 1497029672
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Entity Type | Organization
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Legal Business Name | JENNIFER E JACOBS DPM LLC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 07/24/2014
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Provider Practice Location Address
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Address Line | 1747 LANGFORD DRIVE BLD. 400 STE. 102
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7370
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Country | US
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Telephone | 706-425-5433
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Fax | 770-573-6764
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Provider Business Mailing Address
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Address Line | 1747 LANGFORD DRIVE BLD. 400 STE. 102
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7370
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Country | US
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Telephone | 706-425-5433
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Fax | 770-573-6764
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER E JACOBS
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Credential | DPM
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Telephone | 706-425-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD001149
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License Number State | GA
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