Provider Demographics
NPI:1891743407
Name:SHORT, JAMES BERNARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BERNARD
Last Name:SHORT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1800 HOWELL MILL ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318
Mailing Address - Country:US
Mailing Address - Phone:404-355-8775
Mailing Address - Fax:404-355-8772
Practice Address - Street 1:1800 HOWELL MILL ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318
Practice Address - Country:US
Practice Address - Phone:404-355-8775
Practice Address - Fax:404-355-8772
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-09-23
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Provider Licenses
StateLicense IDTaxonomies
GA023877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD41108Medicare UPIN
GA08BBVWRMedicare ID - Type Unspecified