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General NPI Number Information
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NPI Number | 1629246137
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Entity Type | Organization
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Legal Business Name | EAMON DUTTA, MD PC
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Dates
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Enumeration Date | 02/19/2008
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 2150 PEACHFORD RD SUITE A
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City | ATLANTA
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State | GA
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Zip | 30338-6520
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Country | US
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Telephone | 770-344-9818
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Fax | 770-458-1596
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Provider Business Mailing Address
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Address Line | 2150 PEACHFORD RD SUITE A
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City | ATLANTA
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State | GA
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Zip | 30338-6520
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BILLING
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Name | KENNETH R WARNER
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Credential |
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Telephone | 770-458-1594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 046593
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License Number State | GA
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