Provider Demographics
NPI:1902124050
Name:ROLFS, JENNA ELISE (PA)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:ELISE
Last Name:ROLFS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:2755 S HIGHWAY 14
Practice Address - Street 2:SUITE 2200
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4902
Practice Address - Country:US
Practice Address - Phone:864-849-9555
Practice Address - Fax:864-849-9556
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2015-04-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2057PAMedicaid
SC2057PAMedicaid