Provider Demographics
NPI:1578644258
Name:PERRY, JOHN THEODORE III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THEODORE
Last Name:PERRY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 CORSEA DEL FONTANA WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4397
Mailing Address - Country:US
Mailing Address - Phone:404-554-2196
Mailing Address - Fax:
Practice Address - Street 1:711 CANTON RD NE STE 220
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8949
Practice Address - Country:US
Practice Address - Phone:404-554-2196
Practice Address - Fax:404-554-2415
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0274212085R0202X, 208600000X
GA0272412086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery