Individual
PAUL JANOTKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 OLD DALTON ELLIJAY RD, CHATSWORTH, GA 30705-2029
(706) 517-2093
Mailing address
5010 CAMBERLEY LN, OLDSMAR, FL 34677-5113
(727) 286-6531
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
29748
OK
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
70155
GA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
ME 107308
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61400002
BLUECROSS PROVIDER NUMBER
MD
01
—
70155
MEDICAL LICENSE
GA
01
—
ME 107308
MEDICAL LICENSE
FL
Enumeration date
06/27/2006
Last updated
11/04/2015
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