Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 38523 | GA |
NPI | 1336180991 |
---|---|
Provider Name | Stephanie Jernigan |
First Address | Atlanta, GA 30329-2309 |
Second Address | Atlanta, GA 30329-2309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 25/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F80963 | (02) |