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General NPI Number Information
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NPI Number | 1962068056
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Entity Type | Individual
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Provider Name | JAIRO ANDRES FONSECA MD
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Gender | Male
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 2174 N DRUID HILLS RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-3102
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Country | US
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Telephone | 404-785-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 HAYGOOD DR NE OFC N454
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City | ATLANTA
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State | GA
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Zip | 30322-1119
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Country | US
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Telephone | 404-727-2024
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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 | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number | 92147
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License Number State | GA
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