Provider Demographics
NPI:1881879559
Name:JERALD N KRAMER DPM PC
Entity type:Organization
Organization Name:JERALD N KRAMER DPM PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JERALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-373-2529
Mailing Address - Street 1:215 CLAIREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2505
Mailing Address - Country:US
Mailing Address - Phone:404-373-2529
Mailing Address - Fax:404-373-1655
Practice Address - Street 1:215 CLAIREMONT AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2505
Practice Address - Country:US
Practice Address - Phone:404-373-2529
Practice Address - Fax:404-373-1655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-074261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00561657AOtherMEDICAID PROVIDER NUMBER
GA111050ASCAOtherMEDICARE PROVIDER NUMBER
GA1881879559OtherPODIATRIC SURGICENTER