Healthcare Provider Details

I. General information

NPI: 1780852376
Provider Name (Legal Business Name): JEANNE M SANTOLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JESSE HILL JR DR SE
ATLANTA GA
30303-3032
US

IV. Provider business mailing address

1285 W SPRING ST SE
SMYRNA GA
30080-3634
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44084
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: