MEDICARE: MRS. JENNIFER CARTER WIEGAND ACNP

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	363LF0000X	Family Nurse Practitioner	RN126531	GA
2	363LA2100X	Acute Care Nurse Practitioner	RN126531	GA

General Provider Information

NPI Number	:	1548444573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER CARTER WIEGAND ACNP

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	5281 CLEVELAND HWY
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-2205
Country	:	US
Telephone Number	:	770-983-4611
Fax Number	:	770-983-9143

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	01/04/2021

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