MEDICARE: DR. DOMINIC S CARREIRA 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	207X00000X	Orthopaedic Surgery Physician	ME 0098607	FL
2	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	ME98607	FL
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	ME98607	FL
4	207X00000X	Orthopaedic Surgery Physician	078584	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	90768	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750336046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC S CARREIRA M.D.

Provider Business Mailing Address
First Line	:	2001 PEACHTREE RD NE STE 705
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1476
Country	:	US
Telephone Number	:	404-355-0743
Fax Number	:	855-270-3558

Provider Business Practice Location Address
First Line	:	1163 JOHNSON FERRY RD STE 200
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-2764
Country	:	US
Telephone Number	:	770-977-7777
Fax Number	:	404-355-2136

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/21/2022

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Directions to “ DR. DOMINIC S CARREIRA M.D.” Practice Location

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