Provider Demographics
NPI:1053385930
Name:ARISTIZABAL, JOSE FERNANDO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:FERNANDO
Last Name:ARISTIZABAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2665 N DECATUR RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6149
Mailing Address - Country:US
Mailing Address - Phone:404-294-4018
Mailing Address - Fax:404-294-9161
Practice Address - Street 1:2665 N DECATUR RD
Practice Address - Street 2:SUITE 430
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6149
Practice Address - Country:US
Practice Address - Phone:404-294-4018
Practice Address - Fax:404-294-9161
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA051206207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1053385930OtherNPI
G60313Medicare UPIN