Provider Demographics
NPI:1902886799
Name:KRAMER, JERALD NOEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:NOEL
Last Name:KRAMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JERALD
Other - Middle Name:NOEL
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0000410213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00006223DMedicaid
GA00006223CMedicaid
GA1881879559OtherPODIATRIC SURGICENTER
GA00006223CMedicaid