MEDICARE: ALEXA VICTORIA DANTZLER 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	208000000X	Pediatrics Physician	103932	GA

General Provider Information

NPI Number	:	1174272694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXA VICTORIA DANTZLER MD

Provider Business Mailing Address
First Line	:	12153 PEARL BAY RDG
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-8980
Country	:	US
Telephone Number	:	703-309-3557
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 SHALLOWFORD RD STE 1300
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-7033
Country	:	US
Telephone Number	:	703-309-3557
Fax Number	:

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

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	07/16/2025

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