Basic Information
| Provider Information | |||||||||
| NPI: | 1720269699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIRUZZO | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | SHEA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 PEACHTREE ST NE UNIT 2009 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303081278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043548148 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1133 EAGLES LANDING PKWY | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302815085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786041053 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2007 | ||||||||
| LastUpdateDate: | 01/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 66280 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 0000046012 | TN | N | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.