Provider Demographics
NPI:1972604270
Name:ANDERSON, JOHN L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1800 WATER PL SE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2064
Mailing Address - Country:US
Mailing Address - Phone:770-850-8918
Mailing Address - Fax:770-850-1628
Practice Address - Street 1:1800 WATER PL SE
Practice Address - Street 2:SUITE 220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2061
Practice Address - Country:US
Practice Address - Phone:770-850-8918
Practice Address - Fax:770-850-1628
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0222072084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000268375-CMedicaid
GAD44717Medicare UPIN