=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013097351
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN SWEENEY MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2006
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1365A CLIFTON RD NE SUITE 3300
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30322-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-778-3712
-----------------------------------------------------
Fax | 404-778-5033
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1364 CLIFTON RD NE ROOM H124
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30322-1059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-727-1540
-----------------------------------------------------
Fax | 404-712-5416
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | L2684
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------