Healthcare Provider Details

I. General information

NPI: 1790889285
Provider Name (Legal Business Name): JOSE E GARCIA-CORRADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 EXECUTIVE PARK SOUTH SUITE 3000
ATLANTA GA
30329
US

IV. Provider business mailing address

59 EXECUTIVE PARK SOUTH SUITE 3000
ATLANTA GA
30329
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6318
  • Fax: 404-778-7117
Mailing address:
  • Phone: 404-778-6318
  • Fax: 404-778-7117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number50315
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number50315
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: