Provider Demographics
NPI:1457303638
Name:POLING, JON S (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:S
Last Name:POLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1086 1/2 BAXTER ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6316
Mailing Address - Country:US
Mailing Address - Phone:706-353-0606
Mailing Address - Fax:706-353-0798
Practice Address - Street 1:1086 1/2 BAXTER ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6316
Practice Address - Country:US
Practice Address - Phone:706-353-0606
Practice Address - Fax:706-353-0798
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0500512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13BDDJZMedicare ID - Type Unspecified
GAH37290Medicare UPIN
GA00906848AMedicare ID - Type Unspecified