1295903755 NPI number — JERJIS T ALAJAJI

Table of content: (NPI 1295903755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295903755 NPI number — JERJIS T ALAJAJI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JERJIS T ALAJAJI
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JERJIS T. ALAJAJI, M.D.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295903755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3430
Provider Second Line Business Mailing Address:
ATTN: JACKIE GEE
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48106-3430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-764-7297
Provider Business Mailing Address Fax Number:
734-677-1603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 E SHOTWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39819-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-243-6180
Provider Business Practice Location Address Fax Number:
229-243-3325
Provider Enumeration Date:
02/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ALAJAJI
Authorized Official First Name:
JERJIS
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
734-677-7400

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  058598 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1063496628 . This is a "BS INDVIDUAL ID NBR" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 768852824A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9177139 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00414989 . This is a "RR MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11503726 . This is a "CAQH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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