Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 044056 | GA |
Y | 207R00000X | Internist | 044056 | GA |
Y | 111NI0900X | Internist | 044056 | GA |
N | 207RA0201X | Internist - Allergy & Immunology | 044056GA | GA |
NPI | 1639177066 |
---|---|
Provider Name | Jean Joseph Philippe-Dambreville |
First Address | Alpharetta, GA 30004-5877 |
Second Address | Atlanta, GA 30345-2913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 11/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000884045E | (05) | GA |
D90633 | (02) | GA |