Basic Information
| Provider Information | |||||||||
| NPI: | 1275562332 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEJOUR DONATIEN | ||||||||
| FirstName: | JODINE | ||||||||
| MiddleName: | MADLINE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6085 OLD NATIONAL HWY STE EG | ||||||||
| Address2: | |||||||||
| City: | SOUTH FULTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303494333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4707546360 | ||||||||
| FaxNumber: | 8777807359 | ||||||||
| Practice Location | |||||||||
| Address1: | 6085 OLD NATIONAL HWY STE EG | ||||||||
| Address2: | |||||||||
| City: | SOUTH FULTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303494333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4707546360 | ||||||||
| FaxNumber: | 8777807359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME94380 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 88994 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 003258208A | 05 | GA | MEDICAID |