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General NPI Number Information
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NPI Number | 1881202752
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Entity Type | Organization
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Legal Business Name | ZANDOC GROUP CORP
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 07/16/2020
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Provider Practice Location Address
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Address Line | 2759 DELK RD SE STE 1603
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City | MARIETTA
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State | GA
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Zip | 30067-8887
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Country | US
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Telephone | 678-668-1173
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Fax |
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Provider Business Mailing Address
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Address Line | 2759 DELK RD SE STE 1603
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City | MARIETTA
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State | GA
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Zip | 30067-8887
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Country | US
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Telephone | 678-668-1173
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DARIELLYS DRAGO
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Credential | ARNP
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Telephone | 678-668-1173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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