Provider Demographics
NPI:1376989517
Name:JJP INTERNAL MEDICINE GROUP LLC
Entity Type:Organization
Organization Name:JJP INTERNAL MEDICINE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIPPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-250-1204
Mailing Address - Street 1:5825 GLENRIDGE DR NE
Mailing Address - Street 2:BLDG 2 SUITE 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5387
Mailing Address - Country:US
Mailing Address - Phone:404-250-1204
Mailing Address - Fax:404-250-1205
Practice Address - Street 1:5825 GLENRIDGE DR NE
Practice Address - Street 2:BLDG 2 SUITE 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5387
Practice Address - Country:US
Practice Address - Phone:404-250-1204
Practice Address - Fax:404-250-1205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044056207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000884045EMedicaid