Provider Demographics
NPI:1497863211
Name:ESPINEL, JOSE E (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:E
Last Name:ESPINEL
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 1:119 AMBULANCE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:
Practice Address - Street 1:157 CLINIC AVE STE 302
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117
Practice Address - Country:US
Practice Address - Phone:770-834-3336
Practice Address - Fax:770-832-2331
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066288208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid
AL137003Medicaid
AL601-09272OtherBCBS/AL
GA003110284BMedicaid
202I026584Medicare PIN
610483OtherWELLCARE MEDICAID
610483OtherWELLCARE MEDICARE
GA003110284AMedicaid
GA003110284CMedicaid