Individual
JONATHAN G. KERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1315 JESSE JEWELL PKWY NE, SUITE 300, GAINESVILLE, GA 30501-3822
(770) 219-6520
(770) 219-6521
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
055853
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10045388
AMERIGROUP
GA
01
—
340860
WELLCARE
GA
05
—
461306198B
—
GA
05
—
461306198D
—
GA
01
—
52182967
BCBS
GA
01
—
7769920
CIGNA
GA
Enumeration date
02/02/2006
Last updated
12/02/2020
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