Widjaja, Jani
Widjaja, Jani is an individual health care provider with primary practice located at 1000 Medical Center Blvd Radiology Dept, Lawrenceville GA 30045-7694. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Widjaja, Jani can be contacted via phone (770) 995-4321.Contact Information
Primary practice address
1000 Medical Center Blvd Radiology Dept
Lawrenceville GA 30045-7694
Phone: (770) 995-4321
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | 49221 | Georgia |
Profile Details
| NPI number | 1902881287 |
|---|---|
| LBN Legal business name | Widjaja, Jani |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 9th, 2005 |
| Last updated | Apr 6th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902881287 | NPPES |
| Georgia | MEDICAID | 000890447A |
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