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General NPI Number Information
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NPI Number | 1699132787
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Entity Type | Individual
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Provider Name | JENNIE MATHEN NP-C
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Gender | Female
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 4120 FIVE FORKS TRICKUM RD SW STE 105
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City | LILBURN
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State | GA
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Zip | 30047-8975
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Country | US
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Telephone | 404-778-0421
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Fax |
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Provider Business Mailing Address
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Address Line | 1897 INNSFAIL DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-2525
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Country | US
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Telephone | 678-458-3820
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | RN224236
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN224236
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License Number State | GA
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