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Individual

JEREMY TODD ROYAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1000 JOHNSON FERRY RD, ATLANTA, GA 30342
(404) 851-6323
(404) 303-3747
Mailing address
5605 GLENRIDGE DR STE 325, ATLANTA, GA 30342-1365
(678) 553-7783
(678) 553-7793

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
28589
AL
2085R0202X
Diagnostic Radiology Physician
Primary
67312
GA
2085R0202X
Diagnostic Radiology Physician
MD36307
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
051116333
BCBS
AL
01
051116334
BCBS
AL
01
051116335
BCBS
AL
01
051116336
BCBS
AL
01
051116339
BCBS
AL
01
051116340
BCBS
AL
01
051116341
BCBS
AL
01
051116342
BCBS
AL
01
051116343
BCBS
AL
01
051116344
BCBS
AL
05
06104821
MS
05
129079
AL
05
129080
AL
05
129081
AL
05
129082
AL
05
129083
AL
05
129084
AL
05
129085
AL
05
129086
AL
05
129087
AL
05
129088
AL
Enumeration date
06/07/2007
Last updated
05/06/2019
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