Healthcare Provider Details

I. General information

NPI: 1427095165
Provider Name (Legal Business Name): PAUL STEPHEN DALE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 1ST ST STE 240
MACON GA
31201-8308
US

IV. Provider business mailing address

800 1ST ST STE 240
MACON GA
31201-8308
US

V. Phone/Fax

Practice location:
  • Phone: 478-633-6900
  • Fax: 478-633-2175
Mailing address:
  • Phone: 478-633-6900
  • Fax: 478-633-2175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number033063
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: