Provider Demographics
NPI:1215390828
Name:JAMISON, EMMA (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:LOUISE
Other - Last Name:MOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 BON AIR RD
Mailing Address - Street 2:
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 BON AIR RD
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1702
Practice Address - Country:US
Practice Address - Phone:317-338-7510
Practice Address - Fax:317-338-7540
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA168840207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology