Individual
JACK DONALD JAMES
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1380 MILSTEAD AVE NE, SUITE B, CONYERS, GA 30012-3864
(770) 760-7007
(770) 760-7611
Mailing address
1380 MILSTEAD AVE NE, SUITE B, CONYERS, GA 30012-3864
(770) 760-7007
(770) 760-7611
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
015479
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00155284D
—
GA
Enumeration date
03/15/2006
Last updated
07/08/2007
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