Provider Demographics
NPI:1265413819
Name:FIGUEROA, JOSE M (M D)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:M
Last Name:FIGUEROA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4444 AUSTELL ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106
Mailing Address - Country:US
Mailing Address - Phone:770-948-8031
Mailing Address - Fax:770-948-0849
Practice Address - Street 1:4444 AUSTELL ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106
Practice Address - Country:US
Practice Address - Phone:770-948-8031
Practice Address - Fax:770-948-0849
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA26265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11SCFSPMedicare ID - Type Unspecified
GAE69999Medicare UPIN