Provider Demographics
NPI:1881606440
Name:GEORGE, JESSIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:ANN
Last Name:GEORGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2153
Mailing Address - Street 2:DEPT 1947
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-0002
Mailing Address - Country:US
Mailing Address - Phone:601-944-1717
Mailing Address - Fax:601-944-9780
Practice Address - Street 1:1190 N STATE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2413
Practice Address - Country:US
Practice Address - Phone:601-973-1624
Practice Address - Fax:601-973-1596
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2016-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA13439R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431923Medicaid
LA1431923Medicaid
5H592CJ95Medicare ID - Type Unspecified