Basic Information
Provider Information | |||||||||
NPI: | 1407000821 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TADROS | ||||||||
FirstName: | JOCELYNE | ||||||||
MiddleName: | SAWERIS | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SAWERIS | ||||||||
OtherFirstName: | JOCELYNE | ||||||||
OtherMiddleName: | MAGDY | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MD | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 658 | ||||||||
Address2: |   | ||||||||
City: | GAINESVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 305030658 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7707181122 | ||||||||
FaxNumber: | 7705357445 | ||||||||
Practice Location | |||||||||
Address1: | 743 SPRING ST NE | ||||||||
Address2: |   | ||||||||
City: | GAINESVILLE | ||||||||
State: | GA | ||||||||
PostalCode: | 305013715 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7705353611 | ||||||||
FaxNumber: | 7705357092 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/12/2008 | ||||||||
LastUpdateDate: | 02/18/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/18/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 61652 | GA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 208000000X | 061652 | GA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   | 2080N0001X | 061652 | GA | N |   | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
ID Information
ID | Type | State | Issuer | Description | 8723262 | 01 | GA | CIGNA | OTHER | 558108 | 01 | GA | WELLCARE | OTHER | 01348277 | 01 | GA | AMERIGROUP | OTHER | 52457195 | 01 | GA | BCBS | OTHER | 721175404B | 05 | GA |   | MEDICAID | 3180115 | 01 | GA | UHC | OTHER |