Provider Demographics
NPI:1841566494
Name:JAMESON, KAROLINE KORAH (DO)
Entity Type:Individual
Prefix:
First Name:KAROLINE
Middle Name:KORAH
Last Name:JAMESON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAROLINE
Other - Middle Name:MAMMEN
Other - Last Name:KORAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100296
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0296
Mailing Address - Country:US
Mailing Address - Phone:352-627-9350
Mailing Address - Fax:352-273-9054
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-627-9350
Practice Address - Fax:352-273-9054
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS14231208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program