Basic Information
| Provider Information | |||||||||
| NPI: | 1194137349 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KNEPPAR | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 464 HILLSIDE AVE | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | NEEDHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024941227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177540748 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5354 REYNOLDS ST STE 424 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128195999 | ||||||||
| FaxNumber: | 9128195980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2014 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 079665 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.