MEDICARE: DR. JEAN JOSEPH PHILIPPE-DAMBREVILLE MD

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	207QA0505X	Adult Medicine Physician	44056	GA
2	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	44056	GA
3	207R00000X	Internal Medicine Physician	44056	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639177066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN JOSEPH PHILIPPE-DAMBREVILLE MD

Provider Business Mailing Address
First Line	:	4955 FLYCATCHER DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-5877
Country	:	US
Telephone Number	:	770-826-7658
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 PARKLAKE DR NE STE 425
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-3066
Country	:	US
Telephone Number	:	770-696-5252
Fax Number	:	470-545-2909

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

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	03/24/2025

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Directions to “ DR. JEAN JOSEPH PHILIPPE-DAMBREVILLE MD” Practice Location

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