Provider Demographics
NPI:1558539429
Name:JAIN, ARUN K (MD)
Entity Type:Individual
Prefix:
First Name:ARUN
Middle Name:K
Last Name:JAIN
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 1:2481 HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4691
Mailing Address - Country:US
Mailing Address - Phone:706-592-4077
Mailing Address - Fax:706-592-2598
Practice Address - Street 1:2481 HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-4691
Practice Address - Country:US
Practice Address - Phone:706-592-4077
Practice Address - Fax:706-592-2598
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA027073208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00300044CMedicaid
GA00300044CMedicaid