Individual
MR. JASON R. DIMONDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAAA
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(770) 277-3056
(855) 204-5244
Mailing address
PO BOX 551420, FORT LAUDERDALE, FL 33355-1420
(800) 243-3839
(954) 839-2569
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
006600
GA
367H00000X
Anesthesiologist Assistant
6600
GA
Other
Enumeration date
10/08/2012
Last updated
03/03/2014
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