Provider Demographics
NPI:1932157997
Name:JEMISON, ADA S (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:S
Last Name:JEMISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ADA
Other - Middle Name:S
Other - Last Name:JEMISON-BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7505 FANNIN ST
Mailing Address - Street 2:SUITE 510
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1913
Mailing Address - Country:US
Mailing Address - Phone:713-790-0745
Mailing Address - Fax:713-790-1302
Practice Address - Street 1:7505 FANNIN ST
Practice Address - Street 2:SUITE 510
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1913
Practice Address - Country:US
Practice Address - Phone:713-790-0745
Practice Address - Fax:713-790-1302
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG71762084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1789667-02Medicaid
TXE03995Medicare UPIN
TX1789667-02Medicaid