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

Jacob Landram

Individual provider Physician Assistant · NPI 1114649936

Jacob Landram is a Physician Assistant in Atlanta, Georgia. Qualified in 2023, 3 years ago. Practices with Wellstreet of Georgia PC, a 431-clinician group and accepts Medicare assignment.

Years since qualifying
3
In the registry since
2022

Practice location Address checks out

1800 Howell Mill Rd NW Ste 175
Atlanta, GA 30318-0924
Phone: (404) 607-1777
Fax: (404) 607-1799
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1114649936
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 19, 2022
Last updated in NPPESJuly 16, 2026
Certification dateJuly 16, 2026
Mailing address1800 Howell Mill Rd Nw Ste 175, Atlanta, GA 30318-0924

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Wellstreet Of Georgia Pc — 431 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations10 on file with Medicare

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