| Doctor Name: | JENNIFER DAWN MABRY |
| NPI Number: | 1033590575 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 19465 |
| Business Practice Address: | 151 Peachwood Centre Dr Spartanburg, SC - 293012575 |
| Business Phone Number: | 8645609627 |
| Business Fax Number: | 8645625470 |
| Mailing Address: | Po Box 743070, ATLANTA |
| State: | GA |
| Postal Code: | 303743070 |
| Phone Number: | 8645604304 |
| Fax Number: | 8645604413 |
| NPI Enumeration Date: | 06/10/2015 |
| NPI Last Update Date: | 02/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 19465 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |