Basic Information
Provider Information
NPI: 1003012915
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHN
FirstName: JAYASHREE
MiddleName: SUNIL
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 8824
Address2:  
City: COLUMBUS
State: GA
PostalCode: 319088824
CountryCode: US
TelephoneNumber: 7063203770
FaxNumber: 7063203772
Practice Location
Address1: 2000 16TH AVENUE
Address2:  
City: COLUMBUS
State: GA
PostalCode: 319011665
CountryCode: US
TelephoneNumber: 7063203770
FaxNumber: 7063203772
Other Information
ProviderEnumerationDate: 06/26/2007
LastUpdateDate: 08/02/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X062125GAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2084P0800XMDSTTNN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

ID Information
IDTypeStateIssuerDescription
912624081A05GA MEDICAID
11281205AL MEDICAID


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