MEDICARE: NGINA JEMMOTT MD, MPH

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	251K00000X	Public Health or Welfare Agency
2	207R00000X	Internal Medicine Physician	67479	GA

General Provider Information

NPI Number	:	1649858275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NGINA JEMMOTT MD, MPH

Provider Business Mailing Address
First Line	:	250 PHARR RD NE APT 1609
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2280
Country	:	US
Telephone Number	:	215-307-6880
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 PHARR RD NE APT 1609
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-2280
Country	:	US
Telephone Number	:	215-307-6880
Fax Number	:

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/02/2021

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