Provider Demographics
NPI:1477811370
Name:PIPPIN, JERRID (MD)
Entity Type:Individual
Prefix:
First Name:JERRID
Middle Name:
Last Name:PIPPIN
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 1:4625 MURRAY LN
Mailing Address - Street 2:
Mailing Address - City:YOUNG HARRIS
Mailing Address - State:GA
Mailing Address - Zip Code:30582-3082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NORTHEAST GEORGIA MEDICAL CENTER
Practice Address - Street 2:743 SPRING STREET NE
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-219-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
GA83778207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program