MEDICARE: JENIFER D. NOBLES PAAA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367H00000X	Anesthesiologist Assistant	2569	GA
2	367H00000X	Anesthesiologist Assistant	AA-831	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	515-38482	OTHER	AL	BCBS OF AL

General Provider Information

NPI Number	:	1154318285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENIFER D. NOBLES PAAA

Provider Business Mailing Address
First Line	:	PO BOX 235022
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36123-5022
Country	:	US
Telephone Number	:	334-396-6930
Fax Number	:	334-396-6929

Provider Business Practice Location Address
First Line	:	4401 RIVER CHASE DR
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-7483
Country	:	US
Telephone Number	:	334-732-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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