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General NPI Number Information
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NPI Number | 1497781215
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Entity Type | Individual
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Provider Name | LUCKY JAIN MD
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2015 UPPERGATE DRIVE 3RD FLOOR
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City | ATLANTA
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State | GA
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Zip | 30322-0001
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Country | US
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Telephone | 404-727-1471
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Fax | 404-727-7233
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Provider Business Mailing Address
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Address Line | 2015 UPPERGATE DRIVE 3RD FLOOR
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City | ATLANTA
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State | GA
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Zip | 30322-0001
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Country | US
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Telephone | 404-727-1471
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Fax | 404-727-7233
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number | 038813
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License Number State | GA
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