1386145225 NPI number — ATLANTA PRIME PHYSICIANS LLC

Table of content: DR. JORDAN VERNON JACOBS M.D. (NPI 1215160379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386145225 NPI number — ATLANTA PRIME PHYSICIANS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA PRIME PHYSICIANS LLC
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:
Provider Other Organization Name Type Code:
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:
1386145225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2894
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30096-0050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-844-4855
Provider Business Mailing Address Fax Number:
480-900-8478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10475 MEDLOCK BRIDGE RD STE 420
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30097-4439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-844-4855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
SOFIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
678-815-2997

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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