Healthcare Provider Details

I. General information

NPI: 1558327072
Provider Name (Legal Business Name): DAVID G DILLARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HAWTHORNE AVE SUITE O
ATHENS GA
30606-2168
US

IV. Provider business mailing address

PO BOX 1728
WATKINSVILLE GA
30677-0034
US

V. Phone/Fax

Practice location:
  • Phone: 706-353-0093
  • Fax: 706-353-0094
Mailing address:
  • Phone: 706-353-0093
  • Fax: 706-353-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number040364
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: