Individual
DR. JON L SIEGEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-4440
Mailing address
PO BOX 1746, INDIANAPOLIS, IN 46206-1746
(877) 383-4442
(678) 553-7793
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
034243
GA
2085R0202X
Diagnostic Radiology Physician
Primary
034243
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000604106C
—
GA
01
—
P00990794
RR MEDICARE
GA
Enumeration date
12/09/2005
Last updated
05/27/2021
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