1588661623 NPI number — JEFFRIE L KAMEAN MD

Table of content: JEFFRIE L KAMEAN MD (NPI 1588661623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588661623 NPI number — JEFFRIE L KAMEAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAMEAN
Provider First Name:
JEFFRIE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1588661623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 88587
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNWOODY
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30356-8587
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-299-8320
Provider Business Mailing Address Fax Number:
404-299-3478

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2675 NORTH DECATUR ROAD
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30033-6125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-299-8320
Provider Business Practice Location Address Fax Number:
404-299-3478
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  40115 , 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: G15148 . This is a "COVENTRY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 582662703 . This is a "MAMSI LIFE AND HEALTH INS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 00676035F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 582662703 . This is a "HUMANA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 582662703 . This is a "GOLDEN RULE INSURANCE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 160041XX . This is a "PREFERRED CARE PROVIDER N" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 312895 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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