Individual
JEAN GUSTAVE SHOUMOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 DEKALB MEDICAL PARKWAY, LITHONIA, GA 30058
(404) 501-8492
Mailing address
2801 DEKALB MEDICAL PKWY, STE. 301, LITHONIA, GA 30058-4996
(404) 501-8492
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
062772
GA
207RI0200X
Infectious Disease Physician
062772
GA
208M00000X
Hospitalist Physician
Primary
062772
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003104725C
—
GA
Enumeration date
07/02/2007
Last updated
01/30/2019
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