Individual
JANA DOPSON ILLSTON
Active
Individual
JANA DOPSON ILLSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
78039
GA
207VG0400X
Gynecology Physician
078039
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300034164A
—
GA
01
—
GRP3569
MEDICARE
GA
Enumeration date
06/11/2010
Last updated
06/09/2021
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