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General NPI Number Information
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NPI Number | 1043533649
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Entity Type | Organization
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Legal Business Name | I D SPECIALIST DALTON P C
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 1200 E WALNUT AVE STE 4
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City | DALTON
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State | GA
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Zip | 30721-4191
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Country | US
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Telephone | 706-428-8908
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 E WALNUT AVE STE 4
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City | DALTON
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State | GA
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Zip | 30721-4191
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Country | US
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Telephone | 706-428-8908
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. VALMYTH J ROJAS
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Credential | BBA, PCP
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Telephone | 706-428-8908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 046533
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License Number State | GA
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