Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174V00000X | Clinical Ethicist |
NPI | 1730465097 |
---|---|
Provider Name | Jason Lesandrini |
First Address | Atlanta, GA 30303-3031 |
Second Address | Atlanta, GA 30303-3031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2011 |
Last Update Date | 31/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0 | GRADY (01) | GA |