Healthcare Provider Details

I. General information

NPI: 1407197551
Provider Name (Legal Business Name): ATLANTA AREA ORTHOPEDIC & IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601A PROFESSIONAL DRIVE STE. 130
LAWRENCEVILLE GA
30046
US

IV. Provider business mailing address

PO BOX 150
WATKINSVILLE GA
30677-0004
US

V. Phone/Fax

Practice location:
  • Phone: 678-551-7800
  • Fax: 678-551-7802
Mailing address:
  • Phone: 678-551-7800
  • Fax: 678-551-7802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID G DILLARD
Title or Position: OWNER
Credential: M.D.
Phone: 706-247-1775