Healthcare Provider Details

I. General information

NPI: 1891961934
Provider Name (Legal Business Name): JONATHAN R HOFFMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 FORSYTH ST SUITE 1B
MACON GA
31201-8637
US

IV. Provider business mailing address

1062 FORSYTH ST SUITE 1B
MACON GA
31201-8637
US

V. Phone/Fax

Practice location:
  • Phone: 478-741-1208
  • Fax:
Mailing address:
  • Phone: 478-741-1208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number76862
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: