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General NPI Number Information
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NPI Number | 1306005905
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Entity Type | Individual
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Provider Name | JONATHAN LOUIS ALTOMAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 1005 E MATTHEWS AVE
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City | JONESBORO
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State | AR
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Zip | 72401-4308
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Country | US
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Telephone | 870-935-1242
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Fax | 870-932-6809
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Provider Business Mailing Address
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Address Line | 3146 BEDFORD LN
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City | GERMANTOWN
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State | TN
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Zip | 38139-8037
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Country | US
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Telephone | 870-253-3771
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | T-1764
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 50661
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License Number State | TN
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