Provider Demographics
NPI:1710094644
Name:DEJARNETTE, HUGH MALCOLM JR (MD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:MALCOLM
Last Name:DEJARNETTE
Suffix:JR
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 1:1550 JANMAR RD # B
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5600
Mailing Address - Country:US
Mailing Address - Phone:770-979-9331
Mailing Address - Fax:770-979-8827
Practice Address - Street 1:1550 JANMAR RD # B
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5600
Practice Address - Country:US
Practice Address - Phone:770-979-9331
Practice Address - Fax:770-979-8827
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27365207Q00000X
KY22908207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0004585815OtherAETNA
GA0100558OtherUNITED HEALTHCARE
GA005347OtherBCBS
GA005347OtherBCBS
GA08BBTSKMedicare ID - Type Unspecified