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NPI Code Detail

MEDICARE: JENIFER B. STOVER PA-C

MEDICARE: JENIFER B. STOVER 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
1363AM0700XMedical Physician AssistantPA 9102766FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881887172
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENIFER B. STOVER PA-C
Provider Business Mailing Address
First Line : 5665 NEW NORTHSIDE DR NW
Second Line : SUITE 320
City : ATLANTA
State : GA
Zip : 30328-5831
Country : US
Telephone Number : 770-874-5439
Fax Number : 770-874-5483
Provider Business Practice Location Address
First Line : 368 NE FRANKLIN ST
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-3088
Country : US
Telephone Number : 386-754-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2007
Last Update Date : 08/21/2007

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