MEDICARE: JENNA A NASH PA-C

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	261QP2300X	Primary Care Clinic/Center
2	363A00000X	Physician Assistant	12491	GA

General Provider Information

NPI Number	:	1881435899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA A NASH PA-C

Provider Business Mailing Address
First Line	:	1007 WINDSOR GREEN DR
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-7109
Country	:	US
Telephone Number	:	770-981-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	5255 SNAPFINGER PARK DR STE 110
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035-4066
Country	:	US
Telephone Number	:	770-981-2211
Fax Number	:

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

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	08/28/2024

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