Provider Demographics
NPI:1225088289
Name:ESNARD, JUAN M (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:ESNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-3140
Mailing Address - Country:US
Mailing Address - Phone:478-743-1478
Mailing Address - Fax:478-746-8536
Practice Address - Street 1:2064 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3140
Practice Address - Country:US
Practice Address - Phone:478-745-5035
Practice Address - Fax:478-746-8536
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00560744Medicaid
GA00560744Medicaid
GA06BDCKQMedicare ID - Type Unspecified