Individual
JONATHAN RUSSELL BROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1062 FORSYTH ST STE 1B, MACON, GA 31201-8638
(478) 741-1208
Mailing address
1062 FORSYTH ST STE 1B, MACON, GA 31201-8638
(478) 741-1208
(478) 741-1557
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2022-00009
NC
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
102044
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/21/2013
Last updated
08/19/2025
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