Provider Demographics
NPI:1336136910
Name:HYMAN, JON LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:LAWRENCE
Last Name:HYMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29965
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30359-0965
Mailing Address - Country:US
Mailing Address - Phone:770-363-8770
Mailing Address - Fax:770-436-8042
Practice Address - Street 1:1462 MONTREAL ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-363-8770
Practice Address - Fax:770-436-8042
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040834207X00000X
GA40834207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2011880OtherUHC
GA6684661OtherCIGNA
GA7338226OtherAETNA
GA00897641CMedicaid
GA511I200029Medicare PIN
GA2011880OtherUHC