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General NPI Number Information
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NPI Number | 1760637243
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Entity Type | Organization
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Legal Business Name | DAVID G DILLARD, MD, LLC
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 771 OLD NORCROSS RD SUITE 140
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4317
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Country | US
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Telephone | 678-689-1100
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Fax | 678-689-1104
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Provider Business Mailing Address
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Address Line | PO BOX 1728
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City | WATKINSVILLE
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State | GA
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Zip | 30677-0034
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Country | US
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Telephone | 706-310-0252
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Fax | 706-769-2750
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DAVID G DILLARD
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Credential | MD
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Telephone | 678-689-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 040364
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License Number State | GU
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