Provider Demographics
NPI:1144228693
Name:SCHLOSSBERG, JAY OWEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:OWEN
Last Name:SCHLOSSBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5820 OLD NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3838
Mailing Address - Country:US
Mailing Address - Phone:770-997-2900
Mailing Address - Fax:770-996-0895
Practice Address - Street 1:5820 OLD NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3838
Practice Address - Country:US
Practice Address - Phone:770-997-2900
Practice Address - Fax:770-996-0895
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D30740Medicare UPIN
GA$$$$$$$$$AMedicare PIN