Provider Demographics
NPI:1104006873
Name:JACOB, ANILA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANILA
Middle Name:
Last Name:JACOB
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 1:677 CHURCH STREET
Mailing Address - Street 2:WELLSTAR HOSPITALIST OFFICE
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-2068
Mailing Address - Country:US
Mailing Address - Phone:770-793-7750
Mailing Address - Fax:
Practice Address - Street 1:677 CHURCH STREET
Practice Address - Street 2:WELLSTAR HOSPITALIST GROUP-WELLSTAR KENNESTONE HOSPITAL
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-793-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52455208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist