Provider Demographics
NPI:1205043122
Name:SCIARRETTA, JASON DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:SCIARRETTA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:69 JESSE HILL JR. DRIVE SW
Mailing Address - Street 2:GLENN MEMORIAL BUILDING, 3RD FLOOR
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303
Mailing Address - Country:US
Mailing Address - Phone:404-251-8915
Mailing Address - Fax:404-523-3931
Practice Address - Street 1:69 JESSE HILL JR. DRIVE SW
Practice Address - Street 2:GLENN MEMORIAL BUILDING, 3RD FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-251-8915
Practice Address - Fax:404-523-3931
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCTL34689174400000X
GA82179208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist