MEDICARE: JOHNATHAN PAUL VANSANT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD22682	OR
2	207UN0902X	Nuclear Imaging & Therapy Physician	MD22682	OR
3	207RR0500X	Rheumatology Physician	016295	GA
4	207RR0500X	Rheumatology Physician	40533	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104804863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNATHAN PAUL VANSANT MD

Provider Business Mailing Address
First Line	:	35 HOSPITAL RD
Second Line	:
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-3139
Country	:	US
Telephone Number	:	706-439-6862
Fax Number	:	706-439-6863

Provider Business Practice Location Address
First Line	:	178 HOSPITAL RD
Second Line	:	SUITE B
City	:	BLAIRSVILLE
State	:	GA
Zip	:	30512-3139
Country	:	US
Telephone Number	:	706-439-6862
Fax Number	:	706-439-6863

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/07/2017

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Directions to “ JOHNATHAN PAUL VANSANT MD” Practice Location

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