Provider Demographics
NPI:1841447620
Name:JERALD N KRAMER DPM PC
Entity type:Organization
Organization Name:JERALD N KRAMER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-697-6110
Mailing Address - Street 1:215 CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2505
Mailing Address - Country:US
Mailing Address - Phone:404-697-6110
Mailing Address - Fax:404-373-1655
Practice Address - Street 1:215 CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2505
Practice Address - Country:US
Practice Address - Phone:404-697-6110
Practice Address - Fax:404-373-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00006223DMedicaid
GANPI 1881879559OtherPODIATRIC SURGICENTER
GA00006223CMedicaid
GANPI 1902886799OtherJERALD N KRAMER DPM
GA00006223CMedicaid
GA511G700765Medicare PIN