Provider Demographics
NPI:1447206164
Name:TRANKINA, JON VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:VINCENT
Last Name:TRANKINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:VINCENT
Other - Last Name:TRANKINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:488 KENNESAW AVE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-9409
Mailing Address - Country:US
Mailing Address - Phone:770-427-3075
Mailing Address - Fax:770-427-3261
Practice Address - Street 1:4595 TOWNE LAKE PKWY
Practice Address - Street 2:BLD300, SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-5514
Practice Address - Country:US
Practice Address - Phone:770-509-0089
Practice Address - Fax:678-888-0642
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030681207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE28004Medicare UPIN
10BDHGKMedicare ID - Type Unspecified