Provider Demographics
NPI:1962945683
Name:DALAMON, SOM
Entity type:Individual
Prefix:
First Name:SOM
Middle Name:
Last Name:DALAMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 FRANKS DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-7509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2310 PARKLAKE DR NE
Practice Address - Street 2:SUITE 171
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-2913
Practice Address - Country:US
Practice Address - Phone:678-313-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044-R-1201253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care