Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | GA069127 | GA |
N | 207Q00000X | Family Doctor | MD445581 | PA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | GA069127 | GA |
NPI | 1003059445 |
---|---|
Provider Name | Dr. Jonathan Joel Perkins |
First Address | Decatur, GA 30033-5918 |
Second Address | Decatur, GA 30033-5918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2009 |
Last Update Date | 27/11/2015 |