Jana Dopson Illston, M.D.

Primary specialty

Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) PhysicianTaxonomy code 207VF0040X

License

78039 Issued in GA

Practice address

11975 Morris Rd Ste 310
Alpharetta, GA 30005-4444

Phone

(770) 752-0824

Fax

(770) 752-0845

NPI assigned

Jun 11, 2010

Last updated

Jun 9, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 8, 2024 through Mar 8, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Georgia Obstetrics & Gynecology 2 LLC

  • Obstetrics & Gynecology Physician
  • Atlanta, GA
  • NPI 1447380142

  Single Specialty

  NPD (past)
• Gwinnett OB GYN Associates of Georgia II, LLC

  dba Atlanta Women's Health Group, PC

  • Obstetrics & Gynecology Physician
  • Snellville, GA
  • NPI 1932826328

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1780904896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5780 PEACHTREE DUNWOODY RD STE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421513",
            "telephone_number": "404-303-8035",
            "fax_number": "404-303-1325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11975 MORRIS RD STE 310",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300054444",
            "telephone_number": "770-752-0824",
            "fax_number": "770-752-0845"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "980 Johnson Fy Rd NE Ste 720",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303421628",
            "country_code": "US",
            "telephone_number": "404-252-3898",
            "fax_number": "404-843-0719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ILLSTON",
        "first_name": "JANA",
        "middle_name": "DOPSON",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-06-11",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "GA",
            "license": "078039",
            "primary": false
        },
        {
            "code": "207VF0040X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery",
            "state": "GA",
            "license": "78039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300034164A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "GRP3569",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Alpharetta, GA
• Providers in Alpharetta, GA by specialty
• Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.