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General NPI Number Information
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NPI Number | 1477574473
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Entity Type | Organization
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Legal Business Name | MCCAYSVILLE INTERNAL MEDICINE LLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 6 ELM ST
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City | BLUE RIDGE
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State | GA
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Zip | 30513-2906
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Country | US
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Telephone | 706-492-4294
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Fax | 706-492-4226
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Provider Business Mailing Address
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Address Line | PO BOX 1058
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City | MC CAYSVILLE
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State | GA
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Zip | 30555-1058
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Country | US
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Telephone | 706-492-4294
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Fax | 706-492-4226
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD TIMOTHY JABALEY II
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Credential | M.D.
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Telephone | 706-492-4226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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