Provider Demographics
NPI:1538391776
Name:JAMAIL, BRIAN DAVID (PA-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:DAVID
Last Name:JAMAIL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:189 BO JAMES ST STE 105
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-6199
Mailing Address - Country:US
Mailing Address - Phone:706-782-0016
Mailing Address - Fax:
Practice Address - Street 1:189 BO JAMES ST STE 105
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-6199
Practice Address - Country:US
Practice Address - Phone:706-782-0016
Practice Address - Fax:706-782-0180
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA8827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant