Provider Demographics
NPI:1629484340
Name:BRUSTEIN, JASON ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALEXANDER
Last Name:BRUSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:105 REGENCY PARK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6649
Mailing Address - Country:US
Mailing Address - Phone:770-506-4119
Mailing Address - Fax:770-506-4145
Practice Address - Street 1:105 REGENCY PARK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6649
Practice Address - Country:US
Practice Address - Phone:770-506-4119
Practice Address - Fax:770-506-4145
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA85137207X00000X
PAOT015677207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery