MEDICARE: JENNIFER SUSAN WEBSTER RN

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	163WC1600X	Continuing Education/Staff Development Registered Nurse	RN067358	GA

General Provider Information

NPI Number	:	1770456469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUSAN WEBSTER RN

Provider Business Mailing Address
First Line	:	2468 BROOKCLIFF WAY NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-2002
Country	:	US
Telephone Number	:	770-496-9426
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 SAVOY DR STE 205
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-1073
Country	:	US
Telephone Number	:	770-496-9426
Fax Number	:

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

Provider Enumeration Date	:	09/29/2025
Last Update Date	:	09/29/2025

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