Provider Demographics
NPI:1942660998
Name:CHILES, JENNIFER OTTENWELLER
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:OTTENWELLER
Last Name:CHILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 BURLINGTON RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307
Mailing Address - Country:US
Mailing Address - Phone:706-207-6373
Mailing Address - Fax:
Practice Address - Street 1:1405 CLIFTON RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-785-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical