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General NPI Number Information
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NPI Number | 1699009878
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Entity Type | Organization
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Legal Business Name | DALTON CARDIOLOGY
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 1436 BROADRICK DR SUITE B
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City | DALTON
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State | GA
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Zip | 30720-3176
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Country | US
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Telephone | 706-226-3434
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Fax | 706-226-4820
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Provider Business Mailing Address
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Address Line | 1436 BROADRICK DR SUITE B
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City | DALTON
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State | GA
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Zip | 30720-3176
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Country | US
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Telephone | 706-226-3434
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Fax | 706-226-4820
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Authorized Official
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Title or Position | MANAGER/ADMINISTRATOR
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Name | MS. DIANE GREESON
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Credential |
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Telephone | 706-226-3434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN036308
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License Number State | GA
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