Healthcare Provider Details

I. General information

NPI: 1912059833
Provider Name (Legal Business Name): LELAND SAGE DUDDLESTON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RIVERBURCH PKWY
DALTON GA
30721-8630
US

IV. Provider business mailing address

1000 RIVERBURCH PKWY
DALTON GA
30721-8630
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-2273
  • Fax: 706-217-6543
Mailing address:
  • Phone: 706-226-2273
  • Fax: 706-217-6543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number033073
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: