MEDICARE: DR. JENNIFER L HUNDLEY MD

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	207N00000X	Dermatology Physician	27568	AL
2	207N00000X	Dermatology Physician	4301084162	MI
3	207N00000X	Dermatology Physician	43292	KY
4	207N00000X	Dermatology Physician	069222	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	069222	OTHER	GA	GEORGIA LICENSE

General Provider Information

NPI Number	:	1578778445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER L HUNDLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 52226
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30355-0226
Country	:	US
Telephone Number	:	404-816-7900
Fax Number	:	404-816-7929

Provider Business Practice Location Address
First Line	:	3131 MAPLE DR NE
Second Line	:	SUITE 102
City	:	ATLANTA
State	:	GA
Zip	:	30305-2515
Country	:	US
Telephone Number	:	404-816-7900
Fax Number	:	404-816-7929

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

Provider Enumeration Date	:	05/13/2007
Last Update Date	:	03/28/2013

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