Individual
DR. JACK R. PINES III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
105 REGENCY PARK DR, MCDONOUGH, GA 30253-6649
(770) 506-4119
Mailing address
105 REGENCY PARK DR, MCDONOUGH, GA 30253-6649
(770) 506-4119
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
85822
GA
208100000X
Physical Medicine & Rehabilitation Physician
PGY.203100
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2015
Last updated
06/18/2020
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