Provider Demographics
NPI:1164569570
Name:JEMISON INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:JEMISON INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY PRAKASH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-688-4050
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:24548 US HWY 31
Mailing Address - City:JEMISON
Mailing Address - State:AL
Mailing Address - Zip Code:35085
Mailing Address - Country:US
Mailing Address - Phone:205-688-4050
Mailing Address - Fax:205-688-3207
Practice Address - Street 1:24548 US HWY 31
Practice Address - Street 2:
Practice Address - City:JEMISON
Practice Address - State:AL
Practice Address - Zip Code:35085
Practice Address - Country:US
Practice Address - Phone:205-688-4050
Practice Address - Fax:205-688-3207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17742207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F63111Medicare UPIN