Provider Demographics
NPI:1851370126
Name:GATER, JAMEELAH JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMEELAH
Middle Name:JEAN
Last Name:GATER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 HARMONY XING STE 1
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9546
Mailing Address - Country:US
Mailing Address - Phone:706-484-0884
Mailing Address - Fax:
Practice Address - Street 1:114 HARMONY XING STE 1
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9546
Practice Address - Country:US
Practice Address - Phone:706-484-0884
Practice Address - Fax:706-484-0885
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51321207P00000X
SC28485207P00000X
GA051321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC284855Medicaid
GA695388615EMedicaid
GA695388615EMedicaid
GAH97129Medicare UPIN
SCH971298619Medicare PIN