MEDICARE: JOHN THEODORE PERRY III 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	2085R0202X	Diagnostic Radiology Physician	027421	GA
2	208600000X	Surgery Physician	027421	GA
3	2086S0129X	Vascular Surgery Physician	027241	GA

General Provider Information

NPI Number	:	1578644258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN THEODORE PERRY III M.D.

Provider Business Mailing Address
First Line	:	9140 CORSEA DEL FONTANA WAY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34109-4397
Country	:	US
Telephone Number	:	404-554-2196
Fax Number	:

Provider Business Practice Location Address
First Line	:	711 CANTON RD NE STE 220
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-8949
Country	:	US
Telephone Number	:	404-554-2196
Fax Number	:	404-554-2415

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	03/11/2019

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