Individual
PRAVIN K JAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
380 HOSPITAL DRIVE, SUITE 410, MACON, GA 31217
(478) 746-5644
(478) 745-4849
Mailing address
PO BOX 2564, MACON, GA 31203
(478) 746-5644
(478) 745-4849
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
030794
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000412222M
—
GA
05
—
000412222Q
—
GA
05
—
000412222R
—
GA
05
—
000412222S
—
GA
05
—
200133190A
—
OK
01
—
326171
WELLCARE
GA
01
—
P00057932
RAILROAD MEDICARE
GA
Enumeration date
08/04/2006
Last updated
06/04/2013
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