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Eileen Javellana

Internal Medicine

Allopathic & Osteopathic Physicians

725 Jesse Jewell Pkwy SE, Gainesville, GA 30501-3834

PECOS Enrollment

Based on the most recent information from CMS, provider Eileen Javellana is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1003896952
Provider Type
Individual
Full Name
Javellana, Eileen
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
1/18/2006
Last Updated
5/7/2024

Contact Information

Practice Location

725 Jesse Jewell Pkwy SE, Gainesville, GA 30501-3834

(678) 207-4373

(770) 533-4727

Mailing Location

PO Box 658, Gainesville, GA 30503-0658

(770) 718-1122

(770) 533-4786

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 045841 Georgia
Code 208M00000X	Description Hospitalist Allopathic & Osteopathic Physicians	License 045841 Georgia
Code 207RB0002X	Description Internal Medicine Allopathic & Osteopathic Physicians	License 045841 Georgia

Provider Identifiers

ID	Description	Issuer
ID 000800555E	Description Medicaid	Issuer Unlisted Georgia
ID 582117020045	Description Other	Issuer TRICARE CERTIFIED Georgia
ID 582117020055	Description Other	Issuer TRICARE CERTIFIED Georgia
ID 000800555C	Description Medicaid	Issuer Unlisted Georgia
ID 000800555D	Description Medicaid	Issuer Unlisted Georgia
ID 000800555G	Description Medicaid	Issuer Unlisted Georgia
ID 110211686	Description Other	Issuer RR MEDICARE-GRP # CC4177 Georgia
ID 2448449	Description Other	Issuer CIGNA Georgia
ID 000800555J	Description Medicaid	Issuer Unlisted Georgia
ID 000800555M	Description Medicaid	Issuer Unlisted Georgia
ID 10045921	Description Other	Issuer AMERIGROUP Georgia
ID 110029C048846	Description Other	Issuer TRAILBLAZER HEALTH ENTERPRISES Georgia
ID 11BDRZS	Description Other	Issuer MEDICARE CAHABA GBA Georgia
ID 000800555B	Description Medicaid	Issuer Unlisted Georgia
ID 582117020057	Description Other	Issuer TRICARE CERTIFIED Georgia
ID 0400503	Description Other	Issuer UNITED HEALTHCARE Georgia
ID 000800555F	Description Medicaid	Issuer Unlisted Georgia
ID 000800555K	Description Medicaid	Issuer Unlisted Georgia
ID 000800555N	Description Medicaid	Issuer Unlisted Georgia
ID 340854	Description Other	Issuer WELLCARE Georgia
ID 110211686	Description Other	Issuer PALMETTO RAILROAD MEDICARE PART B Georgia
ID 52598478	Description Other	Issuer BCBS Georgia
ID 582117020	Description Other	Issuer TRICARE CERTIFIED Georgia
ID 783517	Description Other	Issuer ATENA Georgia
ID 000800555H	Description Medicaid	Issuer Unlisted Georgia
ID 000800555I	Description Medicaid	Issuer Unlisted Georgia
ID 000800555L	Description Medicaid	Issuer Unlisted Georgia
ID 767999	Description Other	Issuer COVENTRY HEALTHCARE Georgia

Eileen Javellana

PECOS Enrollment

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