Individual
DR. JAY HOWARD POLOKOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
455 PHILIP BLVD, SUITE 130, KAISER PERMANENTE LAWRENCEVILLE MEDICAL CENTER, LAWRENCEVILLE, GA 30046
(678) 985-5006
(770) 449-9319
Mailing address
3495 PIEDMONT ROAD, NE, NINE PIEDMONT CENTER, ATLANTA, GA 30305
(404) 364-7070
(770) 449-9319
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
026051
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000338511B
—
GA
Enumeration date
04/11/2006
Last updated
04/26/2012
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