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General NPI Number Information
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NPI Number | 1659867711
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Entity Type | Individual
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Provider Name | ADAM DALZELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/02/2018
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Last Update Date | 04/21/2023
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Provider Practice Location Address
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Address Line | 882 PONCE DE LEON AVE NE
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City | ATLANTA
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State | GA
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Zip | 30306-4268
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Country | US
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Telephone | 708-093-0347
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Fax |
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Provider Business Mailing Address
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Address Line | 1026 CALIBRE SPRINGS WAY
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City | ATLANTA
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State | GA
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Zip | 30342-1879
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Country | US
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Telephone | 305-527-8841
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 022090
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 11005
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License Number State | GA
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