MEDICARE: DR. MALINI DOLON SUR M.D.

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	208600000X	Surgery Physician	257588	NY
2	2086X0206X	Surgical Oncology Physician	257588	NY
3	208600000X	Surgery Physician	84909	GA

General Provider Information

NPI Number	:	1679731251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALINI DOLON SUR M.D.

Provider Business Mailing Address
First Line	:	980 JOHNSON FERRY RD STE 170
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1607
Country	:	US
Telephone Number	:	404-300-2140
Fax Number	:

Provider Business Practice Location Address
First Line	:	980 JOHNSON FERRY RD STE 170
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1607
Country	:	US
Telephone Number	:	404-300-2140
Fax Number	:

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

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	02/05/2020

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