Provider Demographics
NPI:1386137552
Name:JEFFREY, DEVIN
Entity type:Individual
Prefix:MR
First Name:DEVIN
Middle Name:
Last Name:JEFFREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S BELAIR RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9112
Mailing Address - Country:US
Mailing Address - Phone:706-305-3533
Mailing Address - Fax:706-305-3534
Practice Address - Street 1:131 S BELAIR RD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9112
Practice Address - Country:US
Practice Address - Phone:706-305-3533
Practice Address - Fax:706-305-3534
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA036-R-0892253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care