Healthcare Provider Details

I. General information

NPI: 1508855172
Provider Name (Legal Business Name): JUEL PATE BORDERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 MARTIN LUTHER KING JR DR NW
ATLANTA GA
30314-2947
US

IV. Provider business mailing address

991 MARTIN LUTHER KING JR DR NW
ATLANTA GA
30314-2947
US

V. Phone/Fax

Practice location:
  • Phone: 404-758-2192
  • Fax: 404-758-9489
Mailing address:
  • Phone: 404-758-2192
  • Fax: 404-758-9489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number010479
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: