Provider Demographics
NPI:1235569401
Name:JABLOW, MITCHELL
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:JABLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3641 CLUBLAND DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4003
Mailing Address - Country:US
Mailing Address - Phone:770-757-3220
Mailing Address - Fax:
Practice Address - Street 1:3641 CLUBLAND DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4003
Practice Address - Country:US
Practice Address - Phone:770-757-3220
Practice Address - Fax:770-971-2996
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13399OtherSTATE OF GA MEDICAL BOARD