Provider Demographics
NPI:1194305706
Name:PALMER, JEREMY MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHAEL
Last Name:PALMER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2570
Mailing Address - Country:US
Mailing Address - Phone:912-785-2100
Mailing Address - Fax:844-848-5854
Practice Address - Street 1:508 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2570
Practice Address - Country:US
Practice Address - Phone:912-785-2100
Practice Address - Fax:844-848-5854
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant