Provider Demographics
NPI:1902884414
Name:SPINOLO, JORGE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:A
Last Name:SPINOLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1072
Mailing Address - Country:US
Mailing Address - Phone:678-289-0549
Mailing Address - Fax:678-289-8756
Practice Address - Street 1:1045 SOUTHCREST DR STE 200
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6113
Practice Address - Country:US
Practice Address - Phone:678-289-0549
Practice Address - Fax:678-289-8756
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA036016207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000509726AIMedicaid
GA000509726AHMedicaid
GA000509726AHMedicaid
GA000509726AIMedicaid
GAE46506Medicare UPIN
GA202I831499Medicare PIN