Individual
JASON DALE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
105 FISCHER MARKETPLACE LN STE 100, SHARPSBURG, GA 30277-3680
(678) 633-3260
Mailing address
1301 WELL BROOK CIRCLE, CONYERS, GA 30012-3873
(770) 922-3023
(770) 929-1016
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3238
GA
207R00000X
Internal Medicine Physician
003238
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063339549PA
—
GA
Enumeration date
10/04/2006
Last updated
04/09/2025
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