Provider Demographics
NPI:1427497353
Name:HIMMELBAUM, JANA RENEE (DO)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:RENEE
Last Name:HIMMELBAUM
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:RENEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5629 HOLIDAY RD
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1519
Mailing Address - Country:US
Mailing Address - Phone:678-765-8622
Mailing Address - Fax:678-765-8621
Practice Address - Street 1:5629 HOLIDAY RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1519
Practice Address - Country:US
Practice Address - Phone:678-765-8622
Practice Address - Fax:678-765-8621
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA75152208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics