Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 022798 | GA |
NPI | 1023096823 |
---|---|
Provider Name | Dr. Pradeep C Jolly |
First Address | Atlanta, GA 30341-1072 |
Second Address | Atlanta, GA 30342-1739 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000294115AA | (05) | GA |
000294115AB | (05) | GA |
D45778 | (02) | GA |