Healthcare Provider Details

I. General information

NPI: 1073551503
Provider Name (Legal Business Name): DYAN M SPINNATO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4321 UNIVERSITY PKWY SUITE 104
EVANS GA
30809-3058
US

IV. Provider business mailing address

208 OAKHURST DR
NORTH AUGUSTA SC
29860-9742
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-2600
  • Fax: 706-854-2601
Mailing address:
  • Phone: 803-279-9666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number05236
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number052636
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: