Jellicorse, Joseph

Jellicorse, Joseph is an individual health care provider with primary practice located at 100 Professional Park Suite 204, Carrollton GA 30117-3874. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jellicorse, Joseph can be contacted via phone (770) 834-3351.

Contact Information

Primary practice address
100 Professional Park Suite 204 Carrollton GA 30117-3874
Phone: (770) 834-3351
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 046974 Georgia

Profile Details

NPI number 1932190535
LBN Legal business name Jellicorse, Joseph
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Sep 19th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932190535 NPPES
Georgia MEDICAID 00823028A
Georgia Other 080157122
Georgia Other 728652

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