Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 038820 | GA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 038820 | GA |
NPI | 1063409555 |
---|---|
Provider Name | Dr. Glenn J. Jonas |
First Address | Kennesaw, GA 30144-3012 |
Second Address | Kennesaw, GA 30144-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 24/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000625633B | (05) | GA |
000625633D | (05) | GA |
000625633E | (05) | GA |
000625633G | (05) | GA |
000625633H | (05) | GA |
F58177 | (02) | GA |