Healthcare Provider Details

I. General information

NPI: 1700370327
Provider Name (Legal Business Name): DALLIN LINDAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 04/08/2024
Certification Date: 04/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 PEACHTREE RD NW
ATLANTA GA
30309-1281
US

IV. Provider business mailing address

2020 PEACHTREE RD NW
ATLANTA GA
30309-1465
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-3580
  • Fax:
Mailing address:
  • Phone: 404-350-7353
  • Fax: 404-603-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number4351041615
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number94137
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: