Individual
JORGE B PISARELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
107 FAIRVIEW PARK DR, DUBLIN, GA 31021-2501
(478) 864-3448
(478) 864-1288
Mailing address
PO BOX 371, WRIGHTSVILLE, GA 31096-0371
(478) 864-3448
(478) 864-1288
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
58914
GA
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
MD027109E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235131137
BCBSM - BLH
MI
05
—
1992795876
—
MI
01
—
58914
MEDICAL LICENSE
GA
Enumeration date
10/24/2005
Last updated
05/12/2015
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