Healthcare Provider Details

I. General information

NPI: 1093074098
Provider Name (Legal Business Name): JOHNATAN LEE HUSKEY CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 05/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 PEACHTREE ROAD, NW, SUITE 100 KASIER PERMANENTE AT PIEDMONT HOSPITAL
ATLANTA GA
30309
US

IV. Provider business mailing address

3495 PIEDMONT ROAD, NE NINE PIEDMONT CENTER
ATLANTA GA
30305
US

V. Phone/Fax

Practice location:
  • Phone: 678-691-6529
  • Fax: 770-840-7464
Mailing address:
  • Phone: 404-504-5678
  • Fax: 770-840-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: