Basic Information
| Provider Information | |||||||||
| NPI: | 1285623850 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUNWOODY PHYSICIAN PRACTICE NETWORK INC | ||||||||
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| OtherOrganizationName: | DBA DOMINION ORTHOPAEDICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 N SHALLOWFORD RD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303386476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704554009 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4500 N SHALLOWFORD RD | ||||||||
| Address2: | SUITE 500 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303386476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704554009 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BIRMINGHAM | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6153737625 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.