MEDICARE: DR. MICHAEL DAN PERRINO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	01052266A	IN

General Provider Information

NPI Number	:	1124118997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DAN PERRINO MD

Provider Business Mailing Address
First Line	:	95 COLLIER RD NW
Second Line	:	SUITE 4075
City	:	ATLANTA
State	:	GA
Zip	:	30309-1796
Country	:	US
Telephone Number	:	404-355-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 MOUNTAINSIDE VILLAGE PKWY
Second Line	:	BUILDING 500
City	:	JASPER
State	:	GA
Zip	:	30143-8694
Country	:	US
Telephone Number	:	706-253-7340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	10/13/2014

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