Provider Demographics
NPI:1265567796
Name:ESTES, JAMESON ANDREW (MD)
Entity type:Individual
Prefix:
First Name:JAMESON
Middle Name:ANDREW
Last Name:ESTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 HERON BAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7008
Mailing Address - Country:US
Mailing Address - Phone:678-583-2111
Mailing Address - Fax:
Practice Address - Street 1:3334 HIGHWAY 155
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3513
Practice Address - Country:US
Practice Address - Phone:770-228-5407
Practice Address - Fax:770-227-1430
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000875025Medicaid
GAH20722Medicare UPIN