Healthcare Provider Details

I. General information

NPI: 1508073966
Provider Name (Legal Business Name): HERMAN A DONATELLI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 PIEDMONT RD NE STE 100
ATLANTA GA
30305
US

IV. Provider business mailing address

PO BOX 387
TUCKER GA
30085-0387
US

V. Phone/Fax

Practice location:
  • Phone: 404-816-9665
  • Fax: 404-816-0950
Mailing address:
  • Phone: 678-612-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number8852
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: