Provider Demographics
NPI:1366441941
Name:BLEACHER, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BLEACHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5461 MERIDIAN MARK RD STE 570
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2807
Mailing Address - Country:US
Mailing Address - Phone:404-785-6895
Mailing Address - Fax:404-785-6896
Practice Address - Street 1:5461 MERIDIAN MARK RD STE 570
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2807
Practice Address - Country:US
Practice Address - Phone:404-785-6895
Practice Address - Fax:404-785-6896
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA421822086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000713611AMedicaid
GAH08170Medicare UPIN