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General NPI Number Information
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NPI Number | 1023096823
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Entity Type | Individual
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Provider Name | PRADEEP C JOLLY MD
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 1100 JOHNSON FY RD NE STE 600
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City | ATLANTA
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State | GA
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Zip | 30342-1739
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Country | US
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Telephone | 404-256-4777
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Fax | 404-256-5515
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Provider Business Mailing Address
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Address Line | 1835 SAVOY DR SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30341-1072
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Country | US
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Telephone | 404-256-4777
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Fax | 404-256-5515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 022798
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License Number State | GA
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