Provider Demographics
NPI:1306849013
Name:JAY, PODALY UNG (MD)
Entity Type:Individual
Prefix:DR
First Name:PODALY
Middle Name:UNG
Last Name:JAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 WHITE CIR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-5801
Mailing Address - Country:US
Mailing Address - Phone:770-424-2226
Mailing Address - Fax:770-424-8787
Practice Address - Street 1:1431 WHITE CIR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5801
Practice Address - Country:US
Practice Address - Phone:770-424-2226
Practice Address - Fax:770-424-8787
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH90202Medicare UPIN