Healthcare Provider Details

I. General information

NPI: 1477165249
Provider Name (Legal Business Name): JASON NASSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 GILMER ST SE
ATLANTA GA
30303-3017
US

IV. Provider business mailing address

615 MICHAEL ST NE STE 201
ATLANTA GA
30322-1047
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number16673
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: