Provider Demographics
NPI:1003853110
Name:WERNER, JONATHAN (PAA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:WERNER
Suffix:
Gender:M
Credentials:PAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 JOHNSON FY RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1605
Mailing Address - Country:US
Mailing Address - Phone:404-785-2008
Mailing Address - Fax:404-785-4496
Practice Address - Street 1:1001 JOHNSON FY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1605
Practice Address - Country:US
Practice Address - Phone:404-785-2008
Practice Address - Fax:404-785-4496
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3192367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002156BMedicaid
GA1982637419OtherGROUP NPI
GA1003853110OtherNPI
GAN343015OtherWELLCARE MEDICAID
GA1003853110OtherNPI
GAS65849Medicare UPIN
GA100002156BMedicaid