Provider Demographics
NPI:1134253727
Name:CLEVELAND, JINNIE S (DMD)
Entity type:Individual
Prefix:MRS
First Name:JINNIE
Middle Name:S
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 OCILLA RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-2222
Mailing Address - Country:US
Mailing Address - Phone:912-389-1600
Mailing Address - Fax:912-383-0485
Practice Address - Street 1:1310 OCILLA RD
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2222
Practice Address - Country:US
Practice Address - Phone:912-389-1600
Practice Address - Fax:912-383-0485
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000822885BMedicaid