Healthcare Provider Details

I. General information

NPI: 1891971149
Provider Name (Legal Business Name): ANDREW CULLEN DENNISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 PEACHTREE RD NW SHEPHERD CENTER
ATLANTA GA
30309-1426
US

IV. Provider business mailing address

2020 PEACHTREE RD NW SHEPHERD CENTER
ATLANTA GA
30309-1426
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-7353
  • Fax: 404-350-7381
Mailing address:
  • Phone: 404-350-7353
  • Fax: 404-350-7381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberBP10623180
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2008-00384
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number062676
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: