Provider Demographics
NPI:1205188737
Name:DIMONDA, JASON R (PAAA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:R
Last Name:DIMONDA
Suffix:
Gender:M
Credentials:PAAA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:954-839-2569
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:770-277-3056
Practice Address - Fax:855-204-5244
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2014-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA6600367H00000X
GA006600367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant