Active NPI
Jose Enrique Guillen Jr., PA-C
- Physician Assistant
- Atlanta, GA
National Provider Identifier
1639524333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1132245
- Practice address
- 1715 Childerlee LN NE
Atlanta, GA 30329-2434 - Phone
- (503) 442-7307
- NPI assigned
- May 1, 2016
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1132245 | TX | Primary |
Addresses
Primary practice location
1715 Childerlee LN NE
Atlanta, GA 30329-2434
Mailing address
7921 Bermejo Rd
Ft Worth, TX 76112-6144
Phone (503) 442-7307
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1132245 | TX | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462060800000",
"number": "1639524333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7921 BERMEJO RD",
"city": "FT WORTH",
"state": "TX",
"postal_code": "761126144",
"telephone_number": "503-442-7307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1715 CHILDERLEE LN NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303292434",
"telephone_number": "503-442-7307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUILLEN",
"first_name": "JOSE",
"middle_name": "ENRIQUE",
"name_suffix": "Jr.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-01",
"last_updated": "2016-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "1132245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.