Provider Demographics
NPI:1619319027
Name:JAMESON A ESTES, MD, PC
Entity Type:Organization
Organization Name:JAMESON A ESTES, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMESON
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-468-7002
Mailing Address - Street 1:545 VENTURE CT
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:GA
Mailing Address - Zip Code:31064-7788
Mailing Address - Country:US
Mailing Address - Phone:706-468-7002
Mailing Address - Fax:
Practice Address - Street 1:545 VENTURE CT
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:GA
Practice Address - Zip Code:31064-7788
Practice Address - Country:US
Practice Address - Phone:706-468-7002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000871241Medicaid
GAH20722Medicare UPIN