Provider Demographics
NPI:1174528384
Name:JACOBS, WILLIAM CARLISLE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CARLISLE
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:CARL
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5669 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1786
Mailing Address - Country:US
Mailing Address - Phone:404-250-6400
Mailing Address - Fax:404-250-6405
Practice Address - Street 1:5669 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 315
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1786
Practice Address - Country:US
Practice Address - Phone:404-250-6400
Practice Address - Fax:404-250-6405
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018679207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000234594UMedicaid
GA000234594CMedicaid
GA000234594KMedicaid
GA000234594XMedicaid
GA000234594SMedicaid
GA000234594TMedicaid
GA000234594QMedicaid
GA000234594RMedicaid
GA000234594SMedicaid
GA000234594UMedicaid
GA000234594RMedicaid