Provider Demographics
NPI:1053368175
Name:THIGPEN HEARN, JENNIFER JERI (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JERI
Last Name:THIGPEN HEARN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:996 BRIDGEWATER WALK
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2049
Mailing Address - Country:US
Mailing Address - Phone:404-583-0090
Mailing Address - Fax:
Practice Address - Street 1:996 BRIDGEWATER WALK
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2049
Practice Address - Country:US
Practice Address - Phone:404-583-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102586367500000X
GA102586367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000796507AMedicaid
GAS57678Medicare UPIN
GA202I433544Medicare PIN