Provider Demographics
NPI:1871565002
Name:KERRICK, JONATHAN G (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:G
Last Name:KERRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-8420
Mailing Address - Fax:
Practice Address - Street 1:1315 JESSE JEWELL PKWY NE
Practice Address - Street 2:SUITE 300
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3822
Practice Address - Country:US
Practice Address - Phone:770-219-6520
Practice Address - Fax:770-219-6521
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0558532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52182967OtherBCBS
GA461306198DMedicaid
GA10045388OtherAMERIGROUP
GA461306198BMedicaid
GA340860OtherWELLCARE
GA7769920OtherCIGNA
GA461306198DMedicaid
GAI27977Medicare UPIN
GA13BDQPZMedicare ID - Type Unspecified