Healthcare Provider Details

I. General information

NPI: 1124100623
Provider Name (Legal Business Name): JANA M MACLEOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE GRADY HEALTH SYSTEM
ATLANTA GA
30303
US

IV. Provider business mailing address

80 JESSE HILL JR DR SE GRADY HEALTH SYSTEM
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-4307
  • Fax:
Mailing address:
  • Phone: 404-616-4307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number54007
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: