Provider Demographics
NPI:1295903755
Name:JERJIS T ALAJAJI
Entity type:Organization
Organization Name:JERJIS T ALAJAJI
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERJIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALAJAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-677-7400
Mailing Address - Street 1:PO BOX 3430
Mailing Address - Street 2:ATTN: JACKIE GEE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-3430
Mailing Address - Country:US
Mailing Address - Phone:800-764-7297
Mailing Address - Fax:734-677-1603
Practice Address - Street 1:1500 E SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4256
Practice Address - Country:US
Practice Address - Phone:229-243-6180
Practice Address - Fax:229-243-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0585982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1063496628OtherBS INDVIDUAL ID NBR
GA768852824AMedicaid
GA9177139OtherCIGNA
GAP00414989OtherRR MEDICARE
GA11503726OtherCAQH
GA30BDNWTMedicare PIN
GA9177139OtherCIGNA