Jennifer Poole OD and Associates

Primary specialty

OptometristTaxonomy code 152W00000X

License

1858 Issued in GA

Legal business name

JENNIFER POOLE OD AND ASSOCIATES

Practice address

2695 Mariner Way
Villa Rica, GA 30180-8496

Phone

(770) 942-9827

Fax

(770) 577-2384

NPI assigned

Oct 23, 2006

Organization subpart

No

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

Authorized official

Name

Jennifer Poole Wilcox, OD

Title

Owner

Phone

(770) 942-9827

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1346323540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1270 ARBOR PLACE MALL",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301357105",
            "telephone_number": "770-942-9827",
            "fax_number": "770-577-2384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2695 MARINER WAY",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301808496",
            "telephone_number": "770-942-9827",
            "fax_number": "770-577-2384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JENNIFER POOLE OD AND ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "POOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-942-9827",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "1858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "652052015A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rashawn Wanya Jackson, DDS
• Deborah Jean Jahnke, APNP
• Mujeeb A Jan, MD
• Mardeea Jartu, LPC
• Stannetta Shonnae Jefferson, MED
• Alicia M Jennings, MD
• Michelae Jennings
• Lynette Jensen, M.ED., CCC-SLP
• Farah Jiwani, DMD
• Elissaveta B Johnson, M. S., R.D., L.D.

• Optometrist in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.