Healthcare Provider Details

I. General information

NPI: 1972536944
Provider Name (Legal Business Name): DONALD W DOLCE MD,CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 NORTHSIDE PKWY NW SUITE #2207
ATLANTA GA
30327-5202
US

IV. Provider business mailing address

4405 NORTHSIDE PARKWAY NW SUITE #2207
ATLANTA GA
30327
US

V. Phone/Fax

Practice location:
  • Phone: 678-819-3776
  • Fax:
Mailing address:
  • Phone: 678-819-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2642
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: