| Dr Jay Howard Polokoff, MD | |
| 455 Philip Blvd, Suite 130, Kaiser Permanente Lawrenceville Medical Center, Lawrenceville, GA 30046 | |
| (678) 985-5006 | |
| (770) 449-9319 | 
| Full Name | Dr Jay Howard Polokoff | 
|---|---|
| Gender | Male | 
| Speciality | Pediatrics | 
| Location | 455 Philip Blvd, Suite 130, Lawrenceville, Georgia | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1467415281 | NPI | - | NPPES | 
| 000338511B | Medicaid | GA | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208000000X | Pediatrics | 026051 (Georgia) | Primary | 
| Entity Name | The Southeast Permanente Medical Group | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1245266956 PECOS PAC ID: 6204829013 Enrollment ID: O20040407000370 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Dr Jay Howard Polokoff, MD 3495 Piedmont Road, Ne, Nine Piedmont Center, Atlanta, GA 30305 Ph: (404) 364-7070 | Dr Jay Howard Polokoff, MD 455 Philip Blvd, Suite 130, Kaiser Permanente Lawrenceville Medical Center, Lawrenceville, GA 30046 Ph: (678) 985-5006 | 
| Howard Ross Ellis, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 665 Duluth Hwy Ste 920, Lawrenceville, GA 30046 Phone: 678-312-5250 | |
| Anuradha N Sheth, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 755 Old Norcross Rd, Lawrenceville, GA 30045 Phone: 770-277-6725 Fax: 770-277-9169 | |
| Dr. Venkateswara Rao Dikkala, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2775 Cruse Rd, Suite 1801, Lawrenceville, GA 30044 Phone: 678-380-9199 Fax: 908-634-2861 | |
| Navneet Kaur Brar, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 1000 Medical Center Blvd, Lawrenceville, GA 30046 Phone: 678-312-3356 | |
| Dr. Claire Dudley Wilkiemeyer, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 945 River Centre Pl, Suite 200, Lawrenceville, GA 30043 Phone: 678-646-0404 | |
| Dr. Anna Jung, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 595 Hurricane Shoals Rd Nw, Suite 300, Lawrenceville, GA 30046 Phone: 770-995-0823 Fax: 770-995-7018 | |
| Scott Darby, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 595 Hurricane Shoals Road Nw, Suite 300, Lawrenceville, GA 30046 Phone: 770-995-0823 Fax: 770-995-7018 |