Healthcare Provider Details

I. General information

NPI: 1467743880
Provider Name (Legal Business Name): LOUIS NICHOLAS CIARDULLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PARKWAY DR NE DEPARTMENT OF EMERGENCY MEDICINE
ATLANTA GA
30312-1212
US

IV. Provider business mailing address

303 PARKWAY DR NE DEPARTMENT OF EMERGENCY MEDICINE
ATLANTA GA
30312-1212
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8850
  • Fax: 404-688-6355
Mailing address:
  • Phone: 404-251-8850
  • Fax: 404-688-6355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number070723
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: