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General NPI Number Information
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NPI Number | 1760121404
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Entity Type | Individual
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Provider Name | JENNIFER GILMORE
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Gender | Female
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 4181 HOSPITAL DR NE
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City | COVINGTON
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State | GA
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Zip | 30014-2541
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Country | US
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Telephone | 167-843-6968
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Fax |
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Provider Business Mailing Address
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Address Line | 105 CUB LN
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City | COVINGTON
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State | GA
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Zip | 30016-5874
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Country | US
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Telephone | 784-369-6806
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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 | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 208984
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License Number State | GA
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