Provider Demographics
NPI:1639177066
Name:PHILIPPE-DAMBREVILLE, JEAN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:JOSEPH
Last Name:PHILIPPE-DAMBREVILLE
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 1:4955 FLYCATCHER DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5877
Mailing Address - Country:US
Mailing Address - Phone:770-826-7658
Mailing Address - Fax:
Practice Address - Street 1:2310 PARKLAKE DR NE STE 144
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2913
Practice Address - Country:US
Practice Address - Phone:770-696-5252
Practice Address - Fax:470-545-2909
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044056GA207RA0201X
GA044056207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000884045EMedicaid
GA11BDQNHMedicare ID - Type Unspecified
GAD90633Medicare UPIN