Healthcare Provider Details

I. General information

NPI: 1659722601
Provider Name (Legal Business Name): DR. JONATHAN ALTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SIGMAN RD NE STE 125
CONYERS GA
30012-3820
US

IV. Provider business mailing address

3100 INTERSTATE NORTH CIR SE STE 500
ATLANTA GA
30339-2296
US

V. Phone/Fax

Practice location:
  • Phone: 678-413-6276
  • Fax: 678-413-6277
Mailing address:
  • Phone: 770-953-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number84606
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number84606
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: