Organization
JAS MEDICAL & WELLNESS CENTER OF GEORGIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OTIS L BONNER III (ATTORNEY)
(770) 940-4975
Entity
Organization
Contact information
Practice address
1075 WHITLOCK AVE SW, SUITE I, MARIETTA, GA 30064-1941
(678) 797-1104
Mailing address
1075 WHITLOCK AVE SW, SUITE I, MARIETTA, GA 30064-1941
(678) 797-1104
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
—
—
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Enumeration date
04/29/2013
Last updated
04/29/2013
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