MEDICARE: JUEL PATE BORDERS PROFESSIONAL CORPORATION

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	207V00000X	Obstetrics & Gynecology Physician		GA

General Provider Information

NPI Number	:	1912996448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUEL PATE BORDERS PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	991 MARTIN LUTHER KING JR DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-2947
Country	:	US
Telephone Number	:	404-758-2192
Fax Number	:

Provider Business Practice Location Address
First Line	:	991 MARTIN LUTHER KING JR DR NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30314-2947
Country	:	US
Telephone Number	:	404-758-2192
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	JUEL PATE BORDERS
Credential	:	M.D.
Telephone Number	:	404-758-2192

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	08/22/2020

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