Provider Demographics
NPI:1235314329
Name:CORSO, JORGE EDUARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:EDUARDO
Last Name:CORSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1085
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2208
Mailing Address - Country:US
Mailing Address - Phone:404-681-3190
Mailing Address - Fax:404-686-3193
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1085
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2208
Practice Address - Country:US
Practice Address - Phone:404-681-3190
Practice Address - Fax:404-686-3193
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0546032086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107206AMedicaid
GA003107206AMedicaid