Healthcare Provider Details

I. General information

NPI: 1619777653
Provider Name (Legal Business Name): IPC DALTON ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 DUG GAP RD
DALTON GA
30720-5004
US

IV. Provider business mailing address

1502 DUG GAP RD
DALTON GA
30720-5004
US

V. Phone/Fax

Practice location:
  • Phone: 706-847-0826
  • Fax: 706-529-9850
Mailing address:
  • Phone: 706-847-0826
  • Fax: 706-529-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA LIDELLE HARE
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 706-847-0826