Provider Demographics
NPI:1992702450
Name:CARLISLE, JEFFREY A (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
Last Name:CARLISLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5901A PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:STE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5382
Mailing Address - Country:US
Mailing Address - Phone:678-892-2020
Mailing Address - Fax:678-538-1950
Practice Address - Street 1:3975 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2817
Practice Address - Country:US
Practice Address - Phone:770-923-5000
Practice Address - Fax:770-717-9325
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037164207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0479686OtherAETNA HMO
GA0891170OtherUHC
GA05200OtherCOVENTRY PPO
GA180025244OtherRR MEDICARE
GA1078920004OtherDME
GA507240OtherBCBS
GA00587067AMedicaid
GA9856OtherCOVENTRY HMO
GA4486398OtherAETNA
GA507240OtherBCBS
GA18BDCWZMedicare PIN
GA4486398OtherAETNA