Provider Demographics
NPI:1013097351
Name:SWEENEY, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:ROOM H124
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-727-1540
Mailing Address - Fax:404-712-5416
Practice Address - Street 1:1365A CLIFTON RD NE
Practice Address - Street 2:SUITE 3300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-3712
Practice Address - Fax:404-778-5033
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL2684208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3181269Medicaid
G14290Medicare UPIN
TX3181269Medicaid