Provider Demographics
NPI:1245270032
Name:FOX, JENNIFER ANN (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:FOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:DALENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-0307
Mailing Address - Country:US
Mailing Address - Phone:770-887-1668
Mailing Address - Fax:770-781-9937
Practice Address - Street 1:475 TRIBBLE GAP RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2478
Practice Address - Country:US
Practice Address - Phone:770-887-1668
Practice Address - Fax:770-781-9937
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN076847363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000619957QMedicaid
GA202I501030Medicare PIN
GA339633OtherWELLCARE
GA202I504551Medicare PIN
GA10045926OtherAMERIGROUP
R94287Medicare UPIN