Individual
JASON DAVID KRANENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSFA
Contact information
Practice address
1415 HIGHWAY 85 N STE 310-147, FAYETTEVILLE, GA 30214-7738
(937) 570-2426
Mailing address
PO BOX 2550, ROWLETT, TX 75030-2550
(214) 227-2457
(214) 764-0880
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
143379
GA
363AS0400X
Surgical Physician Assistant
143379
GA
Other
Enumeration date
08/06/2013
Last updated
11/16/2021
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