Provider Demographics
NPI:1366502155
Name:SEXSON, JAMES A (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:SEXSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 AUSTELL RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1103
Mailing Address - Country:US
Mailing Address - Phone:770-944-0811
Mailing Address - Fax:770-944-0829
Practice Address - Street 1:3875 AUSTELL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1103
Practice Address - Country:US
Practice Address - Phone:770-944-0811
Practice Address - Fax:770-944-0829
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038362207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE14416Medicare UPIN
GA11BDXBFMedicare ID - Type Unspecified