Provider Demographics
NPI:1558355693
Name:ARNOLD, JASON GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:GLEN
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3525 PIEDMONT RD NE
Mailing Address - Street 2:BUILDING 6, SUITE 220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1578
Mailing Address - Country:US
Mailing Address - Phone:404-446-3200
Mailing Address - Fax:
Practice Address - Street 1:2400 BELLEVUE RD STE 21A
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2890
Practice Address - Country:US
Practice Address - Phone:478-328-0281
Practice Address - Fax:478-328-1433
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2017-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA58569207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA966935933Medicaid
GA966935933Medicaid