MEDICARE: DR. DARA PAUL 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	174400000X	Specialist	055417	GA
2	207V00000X	Obstetrics & Gynecology Physician	55417	GA

General Provider Information

NPI Number	:	1588659908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARA PAUL MD

Provider Business Mailing Address
First Line	:	3890 REDWINE RD SW
Second Line	:	STE 210
City	:	ATLANTA
State	:	GA
Zip	:	30331-5509
Country	:	US
Telephone Number	:	404-346-3417
Fax Number	:	404-346-3418

Provider Business Practice Location Address
First Line	:	3890 REDWINE RD SW
Second Line	:	STE 210
City	:	ATLANTA
State	:	GA
Zip	:	30331-5509
Country	:	US
Telephone Number	:	404-346-3417
Fax Number	:	404-346-3418

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	10/30/2019

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Directions to “ DR. DARA PAUL MD” Practice Location

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