Provider Demographics
NPI:1003133091
Name:JARAMILLO-MAYOR, ELISA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:JARAMILLO-MAYOR
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:ELISA
Other - Last Name:JARAMILLO-MAYOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 TIMMS RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-7016
Practice Address - Country:US
Practice Address - Phone:706-625-0022
Practice Address - Fax:706-625-8586
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA070322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003117022AMedicaid