Provider Demographics
NPI:1275237976
Name:SAYALOUNE, JOHNATHAN KHAM
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:KHAM
Last Name:SAYALOUNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 SPRING STREET,
Mailing Address - Street 2:SUITE 710
Mailing Address - City:GAINESILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-219-8730
Mailing Address - Fax:
Practice Address - Street 1:1439 JESSE JEWELL
Practice Address - Street 2:STE. 301
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-219-9445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program