Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1194039388 |
---|---|
Provider Name | Jeffrey Lee Jennell |
First Address | Augusta, GA 30904-6258 |
Second Address | Augusta, GA 30904-6258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2010 |
Last Update Date | 30/07/2010 |