Provider Demographics
NPI:1477574473
Name:MCCAYSVILLE INTERNAL MEDICINE LLC
Entity Type:Organization
Organization Name:MCCAYSVILLE INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:JABALEY II
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-492-4226
Mailing Address - Street 1:PO BOX 1058
Mailing Address - Street 2:
Mailing Address - City:MC CAYSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30555-1058
Mailing Address - Country:US
Mailing Address - Phone:706-492-4294
Mailing Address - Fax:706-492-4226
Practice Address - Street 1:6 ELM ST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-2906
Practice Address - Country:US
Practice Address - Phone:706-492-4294
Practice Address - Fax:706-492-4226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG1562OtherRAILROAD MEDICARE
TN3709117Medicaid
GAGRP7021Medicare PIN
TN3709117Medicaid