MEDICARE: DUSKA V DYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	058168	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	058168	OTHER	GA	GA MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1245253236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSKA V DYER MD

Provider Business Mailing Address
First Line	:	4855 RIVER GREEN PKWY
Second Line	:	SUITE 700
City	:	DULUTH
State	:	GA
Zip	:	30096-8336
Country	:	US
Telephone Number	:	770-622-0880
Fax Number	:	770-622-9875

Provider Business Practice Location Address
First Line	:	4855 RIVER GREEN PKWY
Second Line	:	SUITE 700
City	:	DULUTH
State	:	GA
Zip	:	30096-8336
Country	:	US
Telephone Number	:	770-622-0880
Fax Number	:	770-622-9875

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	04/11/2008

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