MR. JONATHAN DAVID DERRYBERRY JR. CAA
NPI 1831779578
Anesthesiologist Assistant in Rome, GA

Q: What is the provider's specialty?

The provider's specialty is Anesthesiologist Assistant with taxonomy code 367H00000X.

Active since April 08, 2021

304 TURNER MCCALL BLVD SW, ROME, GA 30165(404) 727-5910 Get Directions Write a Review

NPPES record last updated: December 15, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Dec 15, 2022, Apr 8, 2021 (2 updates tracked since 2021).

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About Mr. Jonathan David Derryberry Jr. Caa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JONATHAN DAVID DERRYBERRY JR. CAA (NPI 1831779578) is an individual anesthesiologist assistant in Rome, Georgia and active in the NPI registry since April 2021. He is affiliated with Atrium Health Floyd Medical Center and is a graduate of Emory University School Of Medicine (2022).

NPPES Registry Identity

NPI1831779578

Entity TypeIndividualMale

Primary Taxonomy367H00000X

Provider Legal NameMR. JONATHAN DAVID DERRYBERRY JR.Credential: CAA

Location Address304 TURNER MCCALL BLVD SWRome, GA 30165-5621

Mailing Address304 Turner Mccall Blvd SwRome, GA 30165-5621

Phone(404) 727-5910

Sole ProprietorNo

Medical School CMSEmory University School Of MedicineGraduated 2022

Enumeration DateApril 8, 2021

Last NPPES UpdateDecember 15, 20222 updates tracked since enumeration

NPPES CertifiedDecember 15, 2022

✔ NPI 1831779578 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAnesthesiologist AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367H00000X

Definition

An individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist.

304 TURNER MCCALL BLVD SW, Rome, GA 30165

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Jonathan David Derryberry Jr. Caa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3678945714

PECOS Enrollment IDI20230217001966

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Atrium Health Floyd Medical Center

Acute Care Hospitals · Rome, GA

2/5 CMS rating

OwnershipGovernment - Hospital District or Authority

CMS Certification Number110054

Location304 Turner Mccall BoulevardRome, GA 30162 · Floyd County

Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRISTOFER RYAN FOREMAN P.A.

Physician Assistant (Medical)