Provider Demographics
NPI:1316927262
Name:JAFFAL, ANDY M (MD)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:M
Last Name:JAFFAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AHMAD
Other - Middle Name:M
Other - Last Name:JAFFAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:35 COLLIER RD NW
Mailing Address - Street 2:SUITE 635
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1613
Mailing Address - Country:US
Mailing Address - Phone:404-367-3014
Mailing Address - Fax:404-367-3558
Practice Address - Street 1:35 COLLIER RD NW
Practice Address - Street 2:SUITE 635
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1613
Practice Address - Country:US
Practice Address - Phone:404-367-3014
Practice Address - Fax:404-367-3558
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52670818-006OtherBCBS
FL0034912-00Medicaid
FLFC050YMedicare PIN
GAP00043444OtherRR MEDICARE-GRP # CC4177
GA10045332OtherAMERIGROUP
GA336020OtherWELLCARE
GA3840442OtherCIGNA
GA000758821GMedicaid
FL14C2FOtherBCBS
GA0402015OtherUNITED HEALTHCARE
GAG60457Medicare UPIN