Healthcare Provider Details

I. General information

NPI: 1407323199
Provider Name (Legal Business Name): DPI OF GEORGIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2018
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLONIAL CENTER PKWY STE 100N
ROSWELL GA
30076-4892
US

IV. Provider business mailing address

8946 INTERLINE AVE STE C
BATON ROUGE LA
70809-1913
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-0030
  • Fax: 225-923-0060
Mailing address:
  • Phone: 225-923-0030
  • Fax: 225-923-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT PATRICK GARDINER
Title or Position: OWNER
Credential: MD
Phone: 225-923-0030