Individual
DR. JOSE R JUSTINIANO-AYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
205 JENKINS RD, ROSSVILLE, GA 30741
(706) 866-5520
(706) 866-5502
Mailing address
13570 N MAIN ST, TRENTON, GA 30752-2012
(706) 866-5520
(706) 866-5502
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
46773
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000211956A
—
GA
05
—
000211956C
—
GA
05
—
003138289A
—
GA
05
—
003147280A
—
GA
05
—
003151883A
—
GA
01
—
111028
MEDICARE OSCAR/CERTIFICATION
GA
01
—
111982
MEDICARE/OSCAR/CERTIFICATION
GA
01
—
111985
MEDICARE OSCAR/CERTIFICATION
GA
Enumeration date
02/15/2006
Last updated
06/19/2018
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