Provider Demographics
NPI:1285070706
Name:JJP INTERNAL MEDICINE GROUP LLC
Entity type:Organization
Organization Name:JJP INTERNAL MEDICINE GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PHILIPPE-DAMBREVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-696-5252
Mailing Address - Street 1:4955 FLYCATCHER DR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5877
Mailing Address - Country:US
Mailing Address - Phone:770-826-7658
Mailing Address - Fax:470-545-2909
Practice Address - Street 1:2310 PARKLAKE DR NE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2916
Practice Address - Country:US
Practice Address - Phone:770-696-5252
Practice Address - Fax:470-545-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2022-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044056GA207QA0505X, 207R00000X, 207RA0201X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000884045EMedicaid
GA000884045IMedicaid