Provider Demographics
NPI:1003880576
Name:NEHMETALLAH, JULES M (MD)
Entity Type:Individual
Prefix:
First Name:JULES
Middle Name:M
Last Name:NEHMETALLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-0173
Mailing Address - Country:US
Mailing Address - Phone:912-338-6438
Mailing Address - Fax:
Practice Address - Street 1:410 DARLING AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5246
Practice Address - Country:US
Practice Address - Phone:913-338-6438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055262208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA735143213FMedicaid
P00239396OtherRAILROAD MEDICARE
GA735143213FMedicaid
GAI17609Medicare UPIN