MEDICARE: DR. DAINA ARIEL BLITZ M.D.

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	207L00000X	Anesthesiology Physician	84996	GA

General Provider Information

NPI Number	:	1396123444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAINA ARIEL BLITZ M.D.

Provider Business Mailing Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1059
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-3206
Country	:	US
Telephone Number	:	404-778-3482
Fax Number	:

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

Provider Enumeration Date	:	05/09/2015
Last Update Date	:	07/01/2020

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