Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 054265 | GA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 054265 | GA |
N | 207NS0135X | Procedural Dermatology | 054265 | GA |
NPI | 1306890678 |
---|---|
Provider Name | Dr. Abhik Damian Dhar |
First Address | Duluth, GA 30096-4807 |
Second Address | Duluth, GA 30096-4807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 02/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
603868660A | (05) | GA |
603868660B | (05) | GA |
603868660C | (05) | GA |
H77424 | (02) |