| Doctor Name: | MR. ANTONIO LOGAN JEFFRIES |
| NPI Number: | 1396861233 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CRNP |
| License Number: | SP007991 |
| Business Practice Address: | 1648 Huntingdon Pike Neonatal Intensive Care Unit - 4th Floor Meadowbrook, PA - 190468001 |
| Business Phone Number: | 2159832107 |
| Business Fax Number: | |
| Mailing Address: | 3579 Willowdale Ln, DOUGLASVILLE |
| State: | GA |
| Postal Code: | 301351391 |
| Phone Number: | 7709429794 |
| Fax Number: | |
| NPI Enumeration Date: | 03/22/2007 |
| NPI Last Update Date: | 11/02/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LN0000X |
| License Number: | SP007991 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Neonatal |
| Taxonomy Definition: | |