MEDICARE: MRS. JENNIFER ANN GEORGIA P.A.

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	363AS0400X	Surgical Physician Assistant	5601007054	MI
2	363AM0700X	Medical Physician Assistant	5601007054	MI

General Provider Information

NPI Number	:	1841580180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANN GEORGIA P.A.

Provider Business Mailing Address
First Line	:	2300 HAGGERTY RD
Second Line	:	STE 1110
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323
Country	:	US
Telephone Number	:	248-669-2000
Fax Number	:	248-669-2110

Provider Business Practice Location Address
First Line	:	2300 HAGGERTY RD
Second Line	:	STE 1110
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48323
Country	:	US
Telephone Number	:	248-669-2000
Fax Number	:	248-669-2110

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

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	04/21/2026

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