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General NPI Number Information
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NPI Number | 1801751383
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Entity Type | Individual
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Provider Name | MR. JONATHAN LOUIS
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Gender | Male
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 1745 PHOENIX BLVD STE 300-335
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5591
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Country | US
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Telephone | 929-884-5613
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Fax | 347-577-9445
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Provider Business Mailing Address
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Address Line | 1745 PHOENIX BLVD STE 300-335
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5591
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Country | US
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Telephone | 929-884-5613
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Fax | 347-577-9445
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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 | 003291819A
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License Number State | GA
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