MEDICARE: DR. JAY OWEN SCHLOSSBERG D.O.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	019996	GA

General Provider Information

NPI Number	:	1144228693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY OWEN SCHLOSSBERG D.O.

Provider Business Mailing Address
First Line	:	5820 OLD NATIONAL HWY
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-3838
Country	:	US
Telephone Number	:	770-997-2900
Fax Number	:	770-996-0895

Provider Business Practice Location Address
First Line	:	5820 OLD NATIONAL HWY
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-3838
Country	:	US
Telephone Number	:	770-997-2900
Fax Number	:	770-996-0895

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/30/2011

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