Jose R Justiniano-Ayala, MD
Individual provider Active NPI Family Medicine Physician · Rossville, GA
NPI 1831163898 · NPPES record last updated Jun 19, 2018
Key facts
- NPI
- 1831163898
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 46773 (GA)
- Practice address
- 205 Jenkins Rd
Rossville, GA 30741 - Phone
- (706) 866-5520
- Fax
- (706) 866-5502
- NPI assigned
- Feb 15, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250514003332 | TN | Order and Referring Only - Family Practice |
8426112830 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Primary Health Care Center of Dade, Inc. | Current | Accepting new patients | |
| Hutcheson Primary Care, LLC | Family Medicine | Past | Accepting new patients |
Locations
13570 N Main St
Trenton, GA 30752
Phone (404) 657-7575
Interoperability endpoints
- jose.justiniano.ayala@gadirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 46773 | GA | Yes |
Addresses
Primary practice location
205 Jenkins Rd
Rossville, GA 30741
Mailing address
13570 N Main St
Trenton, GA 30752-2012
Phone (706) 866-5520
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003147280A | Medicaid | GA | |
| 111028 | Other | GA | MEDICARE OSCAR/CERTIFICATION |
| 111985 | Other | GA | MEDICARE OSCAR/CERTIFICATION |
| 003151883A | Medicaid | GA | |
| 000211956A | Medicaid | GA | |
| 000211956C | Medicaid | GA | |
| 003138289A | Medicaid | GA | |
| 111982 | Other | GA | MEDICARE/OSCAR/CERTIFICATION |
Other providers in Rossville, GA
- Dana Jenkins
- Dana Gae Johnson
- Kirstin Joanna Johnson
- Snezana Brady Johnson
- Daniel W. Jordan
- K-VA-T Food Stores Inc
- Aaron Michael Kirkpatrick
- Julie Lynn Kubin
- Kimberly Langford
- Alma Ann Larkin Huff
All providers in Rossville, GA · Family Medicine Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 19, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.