Provider Demographics
NPI:1073263604
Name:CEGLENSKI, JULIA PRAWL (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:PRAWL
Last Name:CEGLENSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1964
Mailing Address - Country:US
Mailing Address - Phone:706-253-4633
Mailing Address - Fax:
Practice Address - Street 1:175 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1964
Practice Address - Country:US
Practice Address - Phone:706-253-4633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
GA100224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program