Basic Information
| Provider Information | |||||||||
| NPI: | 1821037110 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEFNER | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | ALLISTER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 JOHNSON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048518000 | ||||||||
| FaxNumber: | 4048516325 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 JOHNSON FERRY RD | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048518000 | ||||||||
| FaxNumber: | 4048516325 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 37924 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 0037924 | TN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 058420 | GA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1168583 | 01 | GA | CIGNA | OTHER | 4119104 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | 372473269A | 05 | GA | MEDICAID | P00408939 | 01 | GA | MEDICARE RAILROAD | OTHER | 372473269C | 05 | GA | MEDICAID | 244807 | 01 | GA | WELLCARE | OTHER | 3889851 | 05 | TN | MEDICAID | 10075404 | 01 | GA | AMERIGROUP | OTHER | 2318844 | 01 | GA | UHC | OTHER | 372473269D | 05 | GA | MEDICAID | 52205825 001 | 01 | GA | BCBS | OTHER | 7133613 | 01 | GA | AETNA | OTHER |