Healthcare Provider Details

I. General information

NPI: 1033106570
Provider Name (Legal Business Name): PAUL R. JEFFORDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 PEACHTREE DUNWOODY RD NE SUITE 900
ATLANTA GA
30342-5000
US

IV. Provider business mailing address

5671 PEACHTREE DUNWOODY RD NE SUITE 900
ATLANTA GA
30342-5000
US

V. Phone/Fax

Practice location:
  • Phone: 404-847-9999
  • Fax: 404-531-8466
Mailing address:
  • Phone: 404-847-9999
  • Fax: 404-531-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number051238
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number051238
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: