Provider Demographics
NPI:1023488939
Name:LAMINACK, JENNY DICKSON (PA-C)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:DICKSON
Last Name:LAMINACK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:LYNN
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:327 DAHLONEGA ST STE 1501
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040
Mailing Address - Country:US
Mailing Address - Phone:770-844-1902
Mailing Address - Fax:770-205-3991
Practice Address - Street 1:327 DAHLONEGA ST STE 1501
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-844-1902
Practice Address - Fax:770-205-3991
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7759363AM0700X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical