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NPI Code Detail

MEDICARE: DR. SANDEEP DHALIWAL MD

MEDICARE: DR. SANDEEP DHALIWAL 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
1207Q00000XFamily Medicine Physician87239GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
187239OTHERGAMEDICAL LICENSE
21174292882OTHERORGANIZATION NPI
31245731298OTHERGANPI PROVIDER

General Provider Information

NPI Number : 1245731298
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDEEP DHALIWAL MD
Provider Business Mailing Address
First Line : 1685 MARS HILL RD NW STE 201
Second Line :
City : ACWORTH
State : GA
Zip : 30101-7180
Country : US
Telephone Number : 770-485-0031
Fax Number : 678-903-4137
Provider Business Practice Location Address
First Line : 1685 MARS HILL RD NW STE 201
Second Line :
City : ACWORTH
State : GA
Zip : 30101-7180
Country : US
Telephone Number : 770-485-0031
Fax Number : 678-903-4137
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2018
Last Update Date : 01/12/2022

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Directions to “ DR. SANDEEP DHALIWAL MD” Practice Location

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