Jennifer Stanfield Puckett, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6191 Issued in GA

Practice address

1211 Sherwood Park Dr NE Ste B
Gainesville, GA 30501-3444

Phone

(770) 219-4840

NPI assigned

Sep 9, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Medical College of Georgia School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aga Professional Services LLCGroup PAC ID 3870768997, 175 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aga Professional Services, LLC

  • Gastroenterology Physician
  • Atlanta, GA
  • NPI 1063799120
  Medicare reassignment Care Compare group
• Advanced Urgent Care LLC

  • Urgent Care Clinic/Center
  • Braselton, GA
  • NPI 1235614074
  Medicare reassignment
• Aga, LLC

  • Gastroenterology Physician
  • Atlanta, GA
  • NPI 1124064118
  Medicare reassignment
• Northeast Georgia Physicians Group Inc

  • Family Medicine Physician
  • Gainesville, GA
  • NPI 1891745212
  Medicare reassignment
• Wellstreet of Georgia PC

  • Urgent Care Clinic/Center
  • Newnan, GA
  • NPI 1235411547
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1283990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1245547405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 742616",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303742616",
            "telephone_number": "770-219-8420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 SHERWOOD PARK DR NE STE B",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013444",
            "telephone_number": "770-219-4840"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "811 13th St",
            "address_2": "POB 3, Suite 10",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309012700",
            "country_code": "US",
            "telephone_number": "706-434-1590",
            "fax_number": "803-279-6001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "JENNIFER",
        "middle_name": "STANFIELD",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-09",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-02537",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "6191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003121389A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1344PA",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpuckett89347@nghs.gadirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1211 Sherwood Park Dr NE Ste B",
            "city": "Gainesville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "305013444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• PT Med
• Publix Super Markets Inc
• Publix Super Markets, Inc.
• Publix Super Markets, Inc.
• Benjamin N Puckett, M.D.
• Pulmonary Associates of Gainesville, P.C.
• Patrick M. Qualtire, DPM
• Samuel Nii Djangmah Quaynor, MD
• Haley B. Queen, PA
• Kevin Jerome Quinn, RPA

• Physician Assistant in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.