Individual
MR. JEREMY W POOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
951 S BROAD ST, THOMASVILLE, GA 31792-6161
(229) 228-4130
(229) 226-4690
Mailing address
951 S BROAD ST, THOMASVILLE, GA 31792-6161
(229) 228-4130
(229) 226-4690
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
033433
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001417567 10
UNITED HEALTHCARE
GA
01
—
024957
BCBS PROVIDER NUMBER
GA
01
—
11DO266342
CLIA LAB PROVIDER NUMBER
GA
05
—
728528012C
—
GA
01
—
GRP1474
MEDICARE GROUP NUMBER
GA
Enumeration date
10/23/2006
Last updated
03/23/2010
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