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General NPI Number Information
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NPI Number | 1477546166
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Entity Type | Individual
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Provider Name | SANDEEP DATTA MD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 101 PRESTON CT SUITE 103
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City | MACON
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State | GA
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Zip | 31210-5772
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Country | US
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Telephone | 478-745-2385
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Fax | 478-745-1225
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Provider Business Mailing Address
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Address Line | PO BOX 116340
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City | ATLANTA
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State | GA
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Zip | 30368-6340
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Country | US
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Telephone | 706-860-2701
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Fax | 706-860-6484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 050473
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 050473
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 050473
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 050473
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License Number State | GA
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