Provider Demographics
NPI:1558308379
Name:PROLOGO, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:PROLOGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:SUITE AG05
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-712-7033
Mailing Address - Fax:404-712-7970
Practice Address - Street 1:1364 CLIFTON ROAD NE
Practice Address - Street 2:SUITE D111
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-712-7033
Practice Address - Fax:404-712-7970
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2015-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA722942085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000230982OtherUNISON
OH000000516404OtherANTHEM
OH389288OtherWELLCARE
OH752765OtherBUCKEYE
OH2691823Medicaid
OH9808106OtherAETNA
OHP00420609OtherRAILROAD MEDICARE
OH389288OtherWELLCARE