Healthcare Provider Details

I. General information

NPI: 1346298213
Provider Name (Legal Business Name): DENNIS E CHOAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 HIGHWAY 54 W STE 500B
FAYETTEVILLE GA
30214-4556
US

IV. Provider business mailing address

1260 HIGHWAY 54 W STE 100
FAYETTEVILLE GA
30214-4514
US

V. Phone/Fax

Practice location:
  • Phone: 770-719-5660
  • Fax:
Mailing address:
  • Phone: 770-277-4277
  • Fax: 770-716-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number039069
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: