Healthcare Provider Details

I. General information

NPI: 1740273036
Provider Name (Legal Business Name): ANDRE L DENIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 PEACHTREE DUNWOODY RD NE SUITE 720
ATLANTA GA
30328-8102
US

IV. Provider business mailing address

5909 PEACHTREE DUNWOODY RD NE SUITE 720
ATLANTA GA
30328-8102
US

V. Phone/Fax

Practice location:
  • Phone: 770-928-2276
  • Fax: 770-592-2136
Mailing address:
  • Phone: 770-928-2276
  • Fax: 770-592-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number045444
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: