Individual
JOHNATHON J RAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 15TH STREET BI 5070, AUGUSTA, GA 30912
(706) 721-2423
Mailing address
922 BURLINGTON DR, EVANS, GA 30809
(678) 527-9153
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15210
GA
Other
Enumeration date
06/26/2023
Last updated
06/26/2023
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