Healthcare Provider Details

I. General information

NPI: 1285070706
Provider Name (Legal Business Name): JJP INTERNAL MEDICINE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 09/03/2022
Certification Date: 09/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 PARKLAKE DR NE STE 500
ATLANTA GA
30345-2916
US

IV. Provider business mailing address

4955 FLYCATCHER DR
ALPHARETTA GA
30004-5877
US

V. Phone/Fax

Practice location:
  • Phone: 770-696-5252
  • Fax: 470-545-2909
Mailing address:
  • Phone: 770-826-7658
  • Fax: 470-545-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number044056GA
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number044056GA
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number044056GA
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number044056GA
License Number StateGA

VIII. Authorized Official

Name: DR. JEAN JOSEPH PHILIPPE-DAMBREVILLE
Title or Position: OWNER
Credential: MD
Phone: 770-696-5252