MEDICARE: NATHANIEL TYLER DILLARD 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	2086S0129X	Vascular Surgery Physician	113960	GA

General Provider Information

NPI Number	:	1275116451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL TYLER DILLARD MD

Provider Business Mailing Address
First Line	:	4409 WHITE BIRCH PT
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-4312
Country	:	US
Telephone Number	:	678-617-2386
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 MEDICAL CENTER BLVD STE 320
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-7767
Country	:	US
Telephone Number	:	470-325-1160
Fax Number	:	678-701-9860

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

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	06/23/2026

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