Provider Demographics
NPI:1558743187
Name:ROMANCIK, JASON T (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:T
Last Name:ROMANCIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1365 CLIFTON RD NE BLDG B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1013
Mailing Address - Country:US
Mailing Address - Phone:404-712-1722
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON RD NE BLDG B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1003
Practice Address - Country:US
Practice Address - Phone:404-712-1722
Practice Address - Fax:404-251-1899
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2015019423207R00000X
MO2015019928207R00000X
GA010002207RH0003X
GA88687207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine