Individual
JEROME D. HOMISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
7231 ROCKBRIDGE RD, LITHONIA, GA 30058-5918
(678) 710-9270
(470) 365-2880
Mailing address
7231 ROCKBRIDGE RD, LITHONIA, GA 30058-5918
(678) 710-9270
(478) 365-2880
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
34-005148
OH
207Q00000X
Family Medicine Physician
Primary
89940
GA
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
89940
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185128
UNISON MEDICAID
OH
01
—
000000251326
ANTHEM BC/BS
—
01
—
001714142
MOUNTAIN STATE BC/BS
—
01
—
0834271
MOLINA MEDICAID
OH
01
—
1316991870
NPI
—
05
—
2003178000
—
WV
01
—
CE0006
RR MEDICARE
—
Enumeration date
05/20/2006
Last updated
05/10/2022
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