Individual
JOHN F MYNATT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5040 BILL GARDNER PKWY, SUITE 100, LOCUST GROVE, GA 30248-3645
(678) 583-5437
(678) 583-5484
Mailing address
5040 BILL GARDNER PKWY, SUITE 100, LOCUST GROVE, GA 30248-3645
(678) 583-5437
(678) 583-5484
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
041469
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000964785B
—
GA
05
—
000964785J
—
GA
01
—
52701109002
BLUE CROSS BLUE SHIELD
GA
Enumeration date
03/20/2006
Last updated
06/23/2008
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