Provider Demographics
NPI:1891704458
Name:INGVOLDSTAD, JAMES P (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:INGVOLDSTAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:275 COLLIER RD NW
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1710
Mailing Address - Country:US
Mailing Address - Phone:404-355-1285
Mailing Address - Fax:404-351-5840
Practice Address - Street 1:275 COLLIER RD NW
Practice Address - Street 2:SUITE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1710
Practice Address - Country:US
Practice Address - Phone:404-355-1285
Practice Address - Fax:404-351-5840
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-09-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA037239207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBDGZMedicare PIN
GAD25373Medicare UPIN