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NPI Code Detail

MEDICARE: JONATHAN MANUEL LOPEZ

MEDICARE:   JONATHAN MANUEL LOPEZ
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
1246ZC0007XSurgical Assistant

General Provider Information

NPI Number : 1508579756
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN MANUEL LOPEZ
Provider Business Mailing Address
First Line : 2001 PEACHTREE RD NE STE 705
Second Line :
City : ATLANTA
State : GA
Zip : 30309-1476
Country : US
Telephone Number : 404-355-0743
Fax Number :
Provider Business Practice Location Address
First Line : 5505 PEACHTREE DUNWOODY RD STE 200
Second Line :
City : ATLANTA
State : GA
Zip : 30342-1749
Country : US
Telephone Number : 404-350-2450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2023
Last Update Date : 01/03/2023

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Directions to “ JONATHAN MANUEL LOPEZ ” Practice Location

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