Provider Demographics
NPI:1255310447
Name:BIZON, JEFFRY JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JEFFRY
Middle Name:JOSEPH
Last Name:BIZON
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 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-297-2200
Practice Address - Fax:770-534-8139
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043169207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10045204OtherAMERIGROUP
GA000747282FMedicaid
GA329152OtherWELLCARE
GA160054841OtherRR MEDICARE-GRP # CC4177
GA000747282EMedicaid
GA000747282GMedicaid
GA0700385OtherUNITED HEALTHCARE
GA1894227OtherCIGNA
GA52596823OtherBCBS
GA5079605OtherAETNA
GA329152OtherWELLCARE
GA000747282FMedicaid