Individual
JOHN R. DESTITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1800 HOWELL MILL RD NW, SUITE 130, ATLANTA, GA 30318-2538
(404) 355-8775
(404) 355-8772
Mailing address
1800 HOWELL MILL RD NW, SUITE 130, ATLANTA, GA 30318-2538
(404) 355-8775
(404) 355-8772
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
052346
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100069810A
—
OK
01
—
52230468001
BCBS OF GA
GA
05
—
976398941A
—
GA
Enumeration date
05/01/2006
Last updated
04/16/2010
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