MEDICARE: JENNY LYNN COLLIER

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	164W00000X	Licensed Practical Nurse	LPN077030	GA

General Provider Information

NPI Number	:	1659206761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY LYNN COLLIER

Provider Business Mailing Address
First Line	:	270 HERITAGE WALK
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-3875
Country	:	US
Telephone Number	:	770-618-9820
Fax Number	:

Provider Business Practice Location Address
First Line	:	270 HERITAGE WALK
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30188-3875
Country	:	US
Telephone Number	:	770-618-9820
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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