Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 65759 | GA |
NPI | 1639355142 |
---|---|
Provider Name | Dr. Allan Antonio Dias |
First Address | Tucker, GA 30084-3406 |
Second Address | Atlanta, GA 30342-1523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2008 |
Last Update Date | 18/10/2011 |