Healthcare Provider Details

I. General information

NPI: 1396430450
Provider Name (Legal Business Name): JEREMY PARADICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 WHITTINGTON LN
MOULTRIE GA
31788-1393
US

IV. Provider business mailing address

441 WHITTINGTON LN
MOULTRIE GA
31788-1393
US

V. Phone/Fax

Practice location:
  • Phone: 229-456-1128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number1396430450
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: