Provider Demographics
NPI:1790665586
Name:LEVY, JENNA L (LMT, NMT)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:L
Last Name:LEVY
Suffix:
Gender:F
Credentials:LMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4081 CAMARON WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8611
Mailing Address - Country:US
Mailing Address - Phone:678-358-1537
Mailing Address - Fax:
Practice Address - Street 1:912 KILLIAN HILL RD SW STE 103
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8976
Practice Address - Country:US
Practice Address - Phone:678-358-1537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT002154225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist