Healthcare Provider Details

I. General information

NPI: 1225088289
Provider Name (Legal Business Name): JUAN M ESNARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2064 VINEVILLE AVE
MACON GA
31204-3140
US

IV. Provider business mailing address

2064 VINEVILLE AVE
MACON GA
31204-3140
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-5035
  • Fax: 478-746-8536
Mailing address:
  • Phone: 478-743-1478
  • Fax: 478-746-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number037197
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: