Individual
JACK HANSON ANZILOTTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
980 JOHNSON FERRY RD STE 800, ATLANTA, GA 30342-1608
(404) 252-9063
(404) 252-0873
Mailing address
980 JOHNSON FERRY RD, ATLANTA, GA 30342-1626
(703) 389-1425
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
12988
GA
363AS0400X
Surgical Physician Assistant
PA9113011
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105528800
—
FL
Enumeration date
02/05/2020
Last updated
07/30/2025
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