Provider Demographics
NPI:1003896952
Name:JAVELLANA, EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:JAVELLANA
Suffix:
Gender:F
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 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-533-4786
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:678-207-4373
Practice Address - Fax:770-533-4727
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045841207RB0002X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110029C048846OtherTRAILBLAZER HEALTH ENTERPRISES
GA11BDRZSOtherMEDICARE CAHABA GBA
GA000800555BMedicaid
GA000800555DMedicaid
GA000800555HMedicaid
GA000800555NMedicaid
GA783517OtherATENA
GA2448449OtherCIGNA
GA000800555IMedicaid
GA10045921OtherAMERIGROUP
GA582117020OtherTRICARE CERTIFIED
GA582117020045OtherTRICARE CERTIFIED
GA000800555CMedicaid
GA110211686OtherRR MEDICARE-GRP # CC4177
GA582117020057OtherTRICARE CERTIFIED
GA767999OtherCOVENTRY HEALTHCARE
GA000800555FMedicaid
GA000800555KMedicaid
GA000800555MMedicaid
GA110211686OtherPALMETTO RAILROAD MEDICARE PART B
GA52598478OtherBCBS
GA000800555JMedicaid
GA0400503OtherUNITED HEALTHCARE
GA340854OtherWELLCARE
GA000800555EMedicaid
GA000800555GMedicaid
GA000800555LMedicaid
GA582117020055OtherTRICARE CERTIFIED