MEDICARE: DR. JODINE MADLINE SEJOUR DONATIEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME94380	FL
2	207Q00000X	Family Medicine Physician	88994	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275562332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JODINE MADLINE SEJOUR DONATIEN MD

Provider Business Mailing Address
First Line	:	6085 OLD NATIONAL HWY STE EG
Second Line	:
City	:	SOUTH FULTON
State	:	GA
Zip	:	30349-4333
Country	:	US
Telephone Number	:	470-754-6360
Fax Number	:	877-780-7359

Provider Business Practice Location Address
First Line	:	6085 OLD NATIONAL HWY STE EG
Second Line	:
City	:	SOUTH FULTON
State	:	GA
Zip	:	30349-4333
Country	:	US
Telephone Number	:	470-754-6360
Fax Number	:	877-780-7359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	12/27/2021

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