Basic Information
Provider Information
NPI: 1851756068
EntityType: 2
ReplacementNPI:  
OrganizationName: DDAB, LLC
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Mailing Information
Address1: PO BOX 947355
Address2:  
City: ATLANTA
State: GA
PostalCode: 303947355
CountryCode: US
TelephoneNumber: 8883373509
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Practice Location
Address1: 2675 N DECATUR RD
Address2: SUITE 506
City: DECATUR
State: GA
PostalCode: 300336131
CountryCode: US
TelephoneNumber: 4042991679
FaxNumber: 4045087588
Other Information
ProviderEnumerationDate: 12/15/2015
LastUpdateDate: 10/01/2021
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AuthorizedOfficialLastName: KREGER
AuthorizedOfficialFirstName: JAMES
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AuthorizedOfficialTitleorPosition: MANAGER
AuthorizedOfficialTelephone: 2059994132
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IsOrganizationSubpart: N
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NPICertificationDate: 10/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
207L00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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