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General NPI Number Information
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NPI Number | 1710398862
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Entity Type | Individual
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Provider Name | JENET MAMMEN GEORGE MD
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Gender | Female
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Dates
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Enumeration Date | 05/12/2014
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 661 E ALTAMONTE DR STE 115
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-5102
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Country | US
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Telephone | 407-831-4040
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Fax | 407-260-0281
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Provider Business Mailing Address
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Address Line | 6101 BLUE LAGOON DR STE 400
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City | MIAMI
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State | FL
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Zip | 33126-2051
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Country | US
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Telephone | 305-500-2000
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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 | ME131104
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License Number State | FL
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