Healthcare Provider Details

I. General information

NPI: 1285324541
Provider Name (Legal Business Name): NAVTEJ SINGH ATHWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 09/27/2024
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 BROADRICK DRIVE
DALTON GA
30720
US

IV. Provider business mailing address

1200 MEMORIAL DRIVE
DALTON GA
30720
US

V. Phone/Fax

Practice location:
  • Phone: 706-226-8990
  • Fax: 706-529-5317
Mailing address:
  • Phone: 706-226-8996
  • Fax: 706-272-6761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17002
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: