Organization
THREE IN ONE MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STANLEY EARL JACOBS MD (OWNER)
(770) 282-9860
Entity
Organization
Contact information
Practice address
5222 ADDISON TRL SW, LILBURN, GA 30047-6670
(770) 282-9860
Mailing address
5222 ADDISON TRL SW, LILBURN, GA 30047-6670
(770) 282-9860
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
305R00000X
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111564508489
—
GA
Enumeration date
02/13/2017
Last updated
02/13/2017
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