MEDICARE: JIRO ESAKI 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	174400000X	Specialist

General Provider Information

NPI Number	:	1164726345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIRO ESAKI MD

Provider Business Mailing Address
First Line	:	101 PADDOCK CT SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-4923
Country	:	US
Telephone Number	:	678-457-6589
Fax Number	:

Provider Business Practice Location Address
First Line	:	1365 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1013
Country	:	US
Telephone Number	:	404-778-3836
Fax Number	:

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

Provider Enumeration Date	:	01/03/2011
Last Update Date	:	01/03/2011

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