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NPI Code Detail

MEDICARE: MR. BRIAN DAVID JAMAIL PA-C

MEDICARE: MR. BRIAN DAVID JAMAIL PA-C
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
1363A00000XPhysician Assistant
2363A00000XPhysician Assistant8827GA

General Provider Information

NPI Number : 1538391776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN DAVID JAMAIL PA-C
Provider Business Mailing Address
First Line : 189 BO JAMES ST STE 105
Second Line :
City : CLAYTON
State : GA
Zip : 30525-6199
Country : US
Telephone Number : 706-782-0016
Fax Number :
Provider Business Practice Location Address
First Line : 189 BO JAMES ST STE 105
Second Line :
City : CLAYTON
State : GA
Zip : 30525-6199
Country : US
Telephone Number : 706-782-0016
Fax Number : 706-782-0180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2009
Last Update Date : 06/05/2024

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