Active NPI
Mitchell Jablow
- Specialist
- Marietta, GA
National Provider Identifier
1235569401
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 13399
- Practice address
- 3641 Clubland Dr
Marietta, GA 30068-4003 - Phone
- (770) 757-3220
- Fax
- (770) 971-2996
- NPI assigned
- Nov 25, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 13399 | GA | Primary |
Addresses
Primary practice location
3641 Clubland Dr
Marietta, GA 30068-4003
Mailing address
3641 Clubland Dr
Marietta, GA 30068-4003
Phone (770) 757-3220
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 13399 | Other | GA | STATE OF GA MEDICAL BOARD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Urban Family Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Marriage & Family Therapist
- Marietta, GA
- NPI 1215092366
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1385337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1385337600000",
"number": "1235569401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3641 CLUBLAND DR",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300684003",
"telephone_number": "770-757-3220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3641 CLUBLAND DR",
"city": "MARIETTA",
"state": "GA",
"postal_code": "300684003",
"telephone_number": "770-757-3220",
"fax_number": "770-971-2996"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JABLOW",
"first_name": "MITCHELL",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-11-25",
"last_updated": "2013-11-25",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "13399",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF GA MEDICAL BOARD",
"identifier": "13399",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marietta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.