Provider Demographics
NPI:1700049772
Name:MCCLURE, JEREMIAH RAMOS (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:RAMOS
Last Name:MCCLURE
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 1:6501 PEAKE RD
Mailing Address - Street 2:BUILDING 100
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8042
Mailing Address - Country:US
Mailing Address - Phone:478-273-2662
Mailing Address - Fax:
Practice Address - Street 1:6501 PEAKE RD
Practice Address - Street 2:BUILDING 100
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-8042
Practice Address - Country:US
Practice Address - Phone:478-273-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1357OtherMEDICARE GRP