Healthcare Provider Details

I. General information

NPI: 1124087168
Provider Name (Legal Business Name): JOHN A. ZELISKO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COWLES CLINC WAY
GREENSBORO GA
30642-5285
US

IV. Provider business mailing address

1070 MAPLE RIDGE WAY
GREENSBORO GA
30642-3933
US

V. Phone/Fax

Practice location:
  • Phone: 706-454-0159
  • Fax:
Mailing address:
  • Phone: 803-312-2572
  • Fax: 803-765-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21408
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number82717
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: