Basic Information
| Provider Information | |||||||||
| NPI: | 1477811370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIPPIN | ||||||||
| FirstName: | JERRID | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4625 MURRAY LN | ||||||||
| Address2: | |||||||||
| City: | YOUNG HARRIS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305823082 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | NORTHEAST GEORGIA MEDICAL CENTER | ||||||||
| Address2: | 743 SPRING STREET NE | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702199000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2012 | ||||||||
| LastUpdateDate: | 06/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | NC | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 83778 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.