Basic Information
Provider Information
NPI: 1942620406
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AFMAN
FirstName: JENNIFER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
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Mailing Information
Address1: 5780 PEACHTREE DUNWOODY RD STE 300
Address2:  
City: ATLANTA
State: GA
PostalCode: 303421513
CountryCode: US
TelephoneNumber: 4043038035
FaxNumber: 4043031325
Practice Location
Address1: 4800 OLDE TOWNE PKWY STE 800
Address2:  
City: MARIETTA
State: GA
PostalCode: 300684357
CountryCode: US
TelephoneNumber: 7705652233
FaxNumber: 7705652198
Other Information
ProviderEnumerationDate: 04/23/2014
LastUpdateDate: 05/19/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/19/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XRN215326GAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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