Healthcare Provider Details

I. General information

NPI: 1780692574
Provider Name (Legal Business Name): RICHARD C JARRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 S COBB DR SE
SMYRNA GA
30080-6342
US

IV. Provider business mailing address

3949 SOUTH COBB DRIVE
SMYRNA GA
30080
US

V. Phone/Fax

Practice location:
  • Phone: 770-438-5229
  • Fax: 770-438-4356
Mailing address:
  • Phone: 770-438-5229
  • Fax: 770-438-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number033364
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number033364
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number033364
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: