Wilborn, Jerry R

Wilborn, Jerry R is an individual health care provider with primary practice located at 1000 Johnson Ferry Rd Ne , Atlanta GA 30342-1606. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Wilborn, Jerry R can be contacted via phone (404) 851-6936.

Contact Information

Primary practice address
1000 Johnson Ferry Rd Ne Atlanta GA 30342-1606
Phone: (404) 851-6936
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 045666 Georgia

Profile Details

NPI number 1629042999
LBN Legal business name Wilborn, Jerry R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 14th, 2006
Last updated Nov 12th, 2008 - about 16 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 1629042999 NPPES
Georgia MEDICAID 000792503J
Georgia MEDICAID 000792503
Georgia MEDICAID 000792503I
Georgia Other 006083
Georgia Other 10655
Georgia Other 00000011837
Georgia Other 10038155
Georgia Other 380007

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