Provider Demographics
NPI:1134128853
Name:MANDEL, JEFFREY SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SAMUEL
Last Name:MANDEL
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 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-354-6303
Mailing Address - Fax:912-355-8655
Practice Address - Street 1:1326 EISENHOWER DR BLDG 2
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-354-6303
Practice Address - Fax:912-355-8655
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054646208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA650814017AMedicaid
GA853523OtherBCBS
GAP00157243OtherRR MEDICARE
SC186202Medicaid
GAP00157243OtherRR MEDICARE