Provider Demographics
NPI:1497888192
Name:POLEKOFF, JEFFREY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PAUL
Last Name:POLEKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:POLEKOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:558 GRAMERCY DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4871
Mailing Address - Country:US
Mailing Address - Phone:678-644-5639
Mailing Address - Fax:
Practice Address - Street 1:558 GRAMERCY DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4871
Practice Address - Country:US
Practice Address - Phone:678-644-5639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000525357GMedicaid
GAC46649Medicare UPIN