Healthcare Provider Details

I. General information

NPI: 1497863211
Provider Name (Legal Business Name): JOSE E ESPINEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 CLINIC AVE STE 302
CARROLLTON GA
30117
US

IV. Provider business mailing address

119 AMBULANCE DR STE 202
CARROLLTON GA
30117-3857
US

V. Phone/Fax

Practice location:
  • Phone: 770-834-3336
  • Fax: 770-832-2331
Mailing address:
  • Phone: 770-838-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number066288
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: