Provider Demographics
NPI:1114956588
Name:VELAZQUEZ, JEANNETTE (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEANNETTE
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3485 ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-2918
Mailing Address - Country:US
Mailing Address - Phone:770-531-9222
Mailing Address - Fax:
Practice Address - Street 1:3485 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-2918
Practice Address - Country:US
Practice Address - Phone:770-531-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 3247213E00000X
GAPOD 1075213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2771997OtherUHC
GA4384641OtherCIGNA
GA576003162BMedicaid
GA52222642-004OtherBCBS
GA7861901OtherAETNA
GA511I480031OtherMEDICARE PART B