Provider Demographics
NPI:1366405037
Name:JENNINGS, ALICIA M (MD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:M
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:119 AMBULANCE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-838-8563
Practice Address - Street 1:101 QUARTZ DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180
Practice Address - Country:US
Practice Address - Phone:770-456-3839
Practice Address - Fax:770-456-3846
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
GA061901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA673576429CMedicaid
GA673576429CMedicaid
MIH22911Medicare UPIN
MIH22911Medicare UPIN