MEDICARE: JOHN A. ZELISKO 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	207L00000X	Anesthesiology Physician	21408	SC
2	207L00000X	Anesthesiology Physician	82717	GA

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	:	1124087168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN A. ZELISKO MD

Provider Business Mailing Address
First Line	:	1070 MAPLE RIDGE WAY
Second Line	:
City	:	GREENSBORO
State	:	GA
Zip	:	30642-3933
Country	:	US
Telephone Number	:	803-312-2572
Fax Number	:	803-765-1732

Provider Business Practice Location Address
First Line	:	1000 COWLES CLINC WAY
Second Line	:
City	:	GREENSBORO
State	:	GA
Zip	:	30642-5285
Country	:	US
Telephone Number	:	706-454-0159
Fax Number	:

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	09/15/2022

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Directions to “ JOHN A. ZELISKO MD” Practice Location

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