MEDICARE: DR. JENNIE E AUSTIN DMD

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	122300000X	Dentist	DN014284	GA

General Provider Information

NPI Number	:	1841579554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIE E AUSTIN DMD

Provider Business Mailing Address
First Line	:	2900 DELK RD SE
Second Line	:	SUITE 1450
City	:	MARIETTA
State	:	GA
Zip	:	30067-5320
Country	:	US
Telephone Number	:	678-502-5604
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 DELK RD SE
Second Line	:	SUITE 1450
City	:	MARIETTA
State	:	GA
Zip	:	30067-5320
Country	:	US
Telephone Number	:	678-502-5604
Fax Number	:

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

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	08/11/2011

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