Healthcare Provider Details

I. General information

NPI: 1407235682
Provider Name (Legal Business Name): JEREMY DWAYNE COURTNEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

2500 N STATE ST DEPARTMENT OF MEDICINE
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-5478
  • Fax:
Mailing address:
  • Phone: 601-984-5601
  • Fax: 601-984-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number91271
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number91271
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: