Individual
MICHEL JEANNOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 TARA COMMONS DR, LOGANVILLE, GA 30052-8018
(678) 928-9700
(770) 466-1585
Mailing address
101 TARA COMMONS DR, LOGANVILLE, GA 30052-8018
(678) 928-9700
(770) 466-1585
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
065686
GA
207RP1001X
Pulmonary Disease Physician
200901094
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003109685A
—
GA
Enumeration date
01/20/2009
Last updated
12/26/2012
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