Provider Demographics
NPI:1154321479
Name:SINGH, JITENDRA P (MD)
Entity Type:Individual
Prefix:
First Name:JITENDRA
Middle Name:P
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 N DECATUR RD
Mailing Address - Street 2:STE 300
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5949
Mailing Address - Country:US
Mailing Address - Phone:404-296-3111
Mailing Address - Fax:678-686-9521
Practice Address - Street 1:2801 N DECATUR RD
Practice Address - Street 2:STE 300
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5949
Practice Address - Country:US
Practice Address - Phone:404-296-3111
Practice Address - Fax:678-686-9521
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA039943207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00700334BMedicaid
GA00700334BMedicaid
G28443Medicare UPIN