Provider Demographics
NPI:1821037110
Name:HEFNER, JONATHAN ALLISTER (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ALLISTER
Last Name:HEFNER
Suffix:
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 1:1000 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1606
Mailing Address - Country:US
Mailing Address - Phone:404-851-8000
Mailing Address - Fax:404-851-6325
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1606
Practice Address - Country:US
Practice Address - Phone:404-851-8000
Practice Address - Fax:404-851-6325
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37924207R00000X
TN0037924208M00000X
GA058420208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1168583OtherCIGNA
TN4119104OtherBLUE CROSS BLUE SHIELD
GA372473269AMedicaid
GAP00408939OtherMEDICARE RAILROAD
GA372473269CMedicaid
GA244807OtherWELLCARE
TN3889851Medicaid
GA10075404OtherAMERIGROUP
GA2318844OtherUHC
GA372473269DMedicaid
GA52205825 001OtherBCBS
GA7133613OtherAETNA
TN3889851Medicaid
GA372473269AMedicaid
TN3889851Medicaid