Provider Demographics
NPI:1699009878
Name:DALTON CARDIOLOGY
Entity type:Organization
Organization Name:DALTON CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-226-3434
Mailing Address - Street 1:1436 BROADRICK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3176
Mailing Address - Country:US
Mailing Address - Phone:706-226-3434
Mailing Address - Fax:706-226-4820
Practice Address - Street 1:1436 BROADRICK DR
Practice Address - Street 2:SUITE B
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3176
Practice Address - Country:US
Practice Address - Phone:706-226-3434
Practice Address - Fax:706-226-4820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN036308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty