Provider Demographics
NPI:1750888442
Name:LAMANNA, JASON J (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:J
Last Name:LAMANNA
Suffix:
Gender:
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:658 IRWIN ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1630
Mailing Address - Country:US
Mailing Address - Phone:407-312-1245
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:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-778-2190
Practice Address - Fax:404-778-4472
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA10256207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program