Provider Demographics
NPI:1124550488
Name:MOTTS, JONATHAN ADAM BERYMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ADAM BERYMAN
Last Name:MOTTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 277723
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7723
Mailing Address - Country:US
Mailing Address - Phone:864-560-6000
Mailing Address - Fax:
Practice Address - Street 1:550 16TH AVE
Practice Address - Street 2:STE. #100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5699
Practice Address - Country:US
Practice Address - Phone:206-320-2484
Practice Address - Fax:206-320-8173
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85197207Q00000X
390200000X
NC2020-03111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCJ0476067OtherMEDICARE PIN
SCSCJ047J577OtherMEDICARE PIN
SCSCJ0476084OtherMEDICARE PIN