Basic Information
| Provider Information | |||||||||
| NPI: | 1053361345 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PECOT | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | YOUNG | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5461 MERIDIAN MARK RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303423283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047851112 | ||||||||
| FaxNumber: | 4047853600 | ||||||||
| Practice Location | |||||||||
| Address1: | 5461 MERIDIAN MARK RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303423283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047851112 | ||||||||
| FaxNumber: | 4047853600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 06/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | RN168014 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.