Provider Demographics
NPI:1033286067
Name:STERLING, JEREMY L (PA)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:L
Last Name:STERLING
Suffix:
Gender:M
Credentials:PA
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 116276
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6276
Mailing Address - Country:US
Mailing Address - Phone:770-232-8611
Mailing Address - Fax:770-232-8618
Practice Address - Street 1:1700 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2195
Practice Address - Country:US
Practice Address - Phone:770-979-9996
Practice Address - Fax:770-979-1202
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004200367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA561536561AMedicaid
GA32BBBFMMedicare ID - Type Unspecified
GA561536561AMedicaid