MEDICARE: JAIRAJ VAILOOR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		VA
2	390200000X	Student in an Organized Health Care Education/Training Program		GA
3	208M00000X	Hospitalist Physician	068820	GA
4	208600000X	Surgery Physician	0116022713	VA
5	208D00000X	General Practice Physician	068820	GA

General Provider Information

NPI Number	:	1235454745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIRAJ VAILOOR M.D.

Provider Business Mailing Address
First Line	:	6325 HOSPITAL PKWY
Second Line	:	EMORY JOHNS CREEK HOSPITAL
City	:	JOHNS CREEK
State	:	GA
Zip	:	30097-5775
Country	:	US
Telephone Number	:	676-474-7038
Fax Number	:

Provider Business Practice Location Address
First Line	:	2487 CEDARCREST RD STE 714
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-2730
Country	:	US
Telephone Number	:	678-224-5730
Fax Number	:	678-693-7186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	11/19/2019

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