MEDICARE: DR. ROBERT DAVID JANSEN M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	207RN0300X	Nephrology Physician	GA027578	GA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1003811332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DAVID JANSEN M.D.

Provider Business Mailing Address
First Line	:	55 WHITCHER ST NE
Second Line	:	STE 460
City	:	MARIETTA
State	:	GA
Zip	:	30060-1171
Country	:	US
Telephone Number	:	770-427-7389
Fax Number	:	770-427-2845

Provider Business Practice Location Address
First Line	:	55 WHITCHER ST NE
Second Line	:	STE 460
City	:	MARIETTA
State	:	GA
Zip	:	30060-1171
Country	:	US
Telephone Number	:	770-427-7389
Fax Number	:	770-427-2845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	12/10/2012

55 WHITCHER ST NE STE 450
MARIETTA, GA
30060-1171

Practice Phone: 770-800-1882
Practice Fax:

55 WHITCHER ST NE , STE 460
MARIETTA, GA
30060-1171