Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack Hanson Anzilotti, PAC

Individual provider Surgical Physician Assistant · NPI 1730711151

Jack Hanson Anzilotti, PAC is a Physician Assistant in Atlanta, Georgia. Qualified in 2019, 7 years ago. Practices with Northside Surgical Professional Services LLC, a 368-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida and Georgia.

Years since qualifying
7
Licensed in
FL, GA
In the registry since
2020
Specialties on file
2
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

See every abbreviation used in this directory →

Practice location Address checks out

980 Johnson Ferry Rd Ste 800
Atlanta, GA 30342-1608
Phone: (404) 252-9063
Fax: (404) 252-0873
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 89 W Copeland Dr, Orlando, FL 32806-2002 — (321) 841-7550

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 12988 (GA)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA9113011 (FL)

Record details

NPI number1730711151
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedFebruary 5, 2020
Last updated in NPPESJuly 30, 2025
Certification dateJuly 30, 2025
Mailing address980 Johnson Ferry Rd, Atlanta, GA 30342-1626

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Northside Surgical Professional Services Llc — 368 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations8 on file with Medicare

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