Healthcare Provider Details

I. General information

NPI: 1487828661
Provider Name (Legal Business Name): DARRELL RYAN PAHL N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3645 HOWELL FERRY RD
DULUTH GA
30096-3179
US

IV. Provider business mailing address

3645 HOWELL FERRY RD
DULUTH GA
30096-3179
US

V. Phone/Fax

Practice location:
  • Phone: 678-473-4738
  • Fax: 678-473-4739
Mailing address:
  • Phone: 678-473-4738
  • Fax: 678-473-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN165166
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: