Individual
JAESON K. COURSEAULT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3939 LAVISTA RD, STE. E274, ATLANTA, GA 30345
(404) 500-7224
Mailing address
2994 E RAMBLE LN, DECATUR, GA 30033-1120
(404) 500-7224
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
86941
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
Q5992
TX
Other
Enumeration date
05/31/2012
Last updated
09/13/2021
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