Healthcare Provider Details

I. General information

NPI: 1790841120
Provider Name (Legal Business Name): BARBARA A DAMPOG M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 BUCKEYE RD SUITE 178
ATLANTA GA
30341-4229
US

IV. Provider business mailing address

6179 WINDSONG WAY
STONE MOUNTAIN GA
30087-1945
US

V. Phone/Fax

Practice location:
  • Phone: 770-458-6103
  • Fax:
Mailing address:
  • Phone: 770-923-5495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number018136
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: