Provider Demographics
NPI:1922794700
Name:BOZEMAN, JEFFREY ANTONIO
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ANTONIO
Last Name:BOZEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 GOSSAMER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4688
Mailing Address - Country:US
Mailing Address - Phone:470-631-4564
Mailing Address - Fax:
Practice Address - Street 1:7921 GOSSAMER DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4688
Practice Address - Country:US
Practice Address - Phone:470-631-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider