Basic Information
Provider Information | |||||||||
NPI: | 1356506836 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FIELDS | ||||||||
FirstName: | DENNIS | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3495 PIEDMONT RD NE BLDG 9 3RD FLOOR | ||||||||
Address2: | ATTN: TOBIE SHELLEY | ||||||||
City: | ATLANTA | ||||||||
State: | GA | ||||||||
PostalCode: | 303051736 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4043650966 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2701 N DECATUR RD | ||||||||
Address2: | SUITE 520 | ||||||||
City: | DECATUR | ||||||||
State: | GA | ||||||||
PostalCode: | 300335918 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4045015227 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/23/2008 | ||||||||
LastUpdateDate: | 04/14/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/14/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 064929 | GA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 064929 | GA | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
No ID Information.