Provider Demographics
NPI:1255573952
Name:JEAN-GILLES, MARC ANDRE (DO)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANDRE
Last Name:JEAN-GILLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601A PROFESSIONAL DRIVE
Mailing Address - Street 2:STE 370
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046
Mailing Address - Country:US
Mailing Address - Phone:678-869-5145
Mailing Address - Fax:678-869-5148
Practice Address - Street 1:601 PROFESSIONAL DR STE 370
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7670
Practice Address - Country:US
Practice Address - Phone:678-869-5145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOTO11290207V00000X
GA62720207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology