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General NPI Number Information
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NPI Number | 1679347033
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Entity Type | Organization
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Legal Business Name | DARTMOUTH MEDICAL LLC
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Dates
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Enumeration Date | 11/07/2023
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 2959 SHARPSBURG MCCULLUM RD # 103
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City | NEWNAN
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State | GA
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Zip | 30265-2297
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Country | US
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Telephone | 617-610-9339
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Fax |
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Provider Business Mailing Address
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Address Line | 2959 SHARPSBURG MCCULLUM RD # 103
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City | NEWNAN
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State | GA
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Zip | 30265-2297
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Country | US
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Telephone | 770-202-1642
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Fax | 770-202-1643
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Authorized Official
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Title or Position | CEO
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Name | JIAN LIANG PANG
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Credential | MD
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Telephone | 617-610-9339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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