Healthcare Provider Details

I. General information

NPI: 1639408123
Provider Name (Legal Business Name): DKUMAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2009
Last Update Date: 12/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3903 SOUTH COBB DRIVE SUITE 200
SMYRNA GA
30080
US

IV. Provider business mailing address

1110 SKYLAR LANE
LITHIA SPRINGS GA
30122
US

V. Phone/Fax

Practice location:
  • Phone: 770-333-7888
  • Fax:
Mailing address:
  • Phone: 770-333-7888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: REENA PATEL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 770-333-7888