MEDICARE: JOHN S ANTALIS M.D.

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	26767	GA

General Provider Information

NPI Number	:	1265420731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN S ANTALIS M.D.

Provider Business Mailing Address
First Line	:	4300 N POINT PKWY STE 300
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30022-4102
Country	:	US
Telephone Number	:	770-442-1911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 N THORNTON AVE STE 107
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-8394
Country	:	US
Telephone Number	:	67-278-0138
Fax Number	:

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	10/02/2023

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