Healthcare Provider Details

I. General information

NPI: 1265567796
Provider Name (Legal Business Name): JAMESON ANDREW ESTES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 HIGHWAY 155
LOCUST GROVE GA
30248-3513
US

IV. Provider business mailing address

5128 HERON BAY BLVD
LOCUST GROVE GA
30248-7008
US

V. Phone/Fax

Practice location:
  • Phone: 770-228-5407
  • Fax: 770-227-1430
Mailing address:
  • Phone: 678-583-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number048852
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: