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Individual

JASON L KONZELMANN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3899
(678) 357-9327
Mailing address
P.O. BOX 6002, URBANA, IL 61803-6002
(217) 326-8300
(217) 326-2856

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
59990
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
202I935064
MEDICARE OF GA
GA
Enumeration date
01/12/2007
Last updated
01/30/2019
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