Healthcare Provider Details

I. General information

NPI: 1417117797
Provider Name (Legal Business Name): JONATHAN ARTHUR COLASANTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 PONCE DE LEON AVE NE
ATLANTA GA
30308-2012
US

IV. Provider business mailing address

341 PONCE DE LEON AVE NE RM 6028
ATLANTA GA
30308-2012
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-2493
  • Fax: 404-616-0592
Mailing address:
  • Phone: 404-616-2493
  • Fax: 404-616-0592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number70867
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number70867
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: