Provider Demographics
NPI:1427143148
Name:HYLAND, JOHN SUMNER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SUMNER
Last Name:HYLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2800 HIGHWAY 138 SW STE A
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3929
Mailing Address - Country:US
Mailing Address - Phone:770-602-2970
Mailing Address - Fax:404-367-6982
Practice Address - Street 1:2800 HIGHWAY 138 SW STE A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3929
Practice Address - Country:US
Practice Address - Phone:770-602-2970
Practice Address - Fax:404-367-6982
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035909207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00516403AMedicaid
F40180Medicare UPIN
GA11BDFPRMedicare ID - Type Unspecified