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General NPI Number Information
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NPI Number | 1609295765
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Entity Type | Individual
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Provider Name | JENSIL PHILIP DANIEL D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 1700 TREE LN STE 190
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City | SNELLVILLE
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State | GA
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Zip | 30078-6766
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Country | US
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Telephone | 470-387-3010
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Fax |
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Provider Business Mailing Address
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Address Line | 20 WOLVERTON CT
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-2514
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS018894
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 80429
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License Number State | GA
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