Provider Demographics
NPI:1801853908
Name:TURNBULL, TIMOTHY LEE (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEE
Last Name:TURNBULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 116301
Mailing Address - Street 2:PARAGON EMERGENCY PHYSICIANS PC
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6301
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:1700 MEDICAL WAY
Practice Address - Street 2:EASTSIDE MEDICAL CENTER
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30278
Practice Address - Country:US
Practice Address - Phone:770-736-2376
Practice Address - Fax:770-736-2379
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA039496207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00630803BMedicaid
GA93BDKVCMedicare ID - Type Unspecified
GA00630803BMedicaid