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General NPI Number Information
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NPI Number | 1386940146
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Entity Type | Individual
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Provider Name | JONATHAN MAURICE WORTHAM MD
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Gender | Male
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Dates
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Enumeration Date | 01/26/2011
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Last Update Date | 10/30/2022
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Provider Practice Location Address
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Address Line | 1600 CLIFTON RD NE MAILSTOP E-10
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City | ATLANTA
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State | GA
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Zip | 30329-4018
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Country | US
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Telephone | 404-639-8955
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Fax | 404-639-9967
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Provider Business Mailing Address
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Address Line | 1600 CLIFTON RD NE MAILSTOP E-10
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City | ATLANTA
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State | GA
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Zip | 30329-4018
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Country | US
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Telephone | 404-639-8955
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Fax | 404-639-9967
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 66343
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License Number State | GA
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