Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101233236 | VA |
Y | 207X00000X | Orthopaedic Surgeon | 69632 | GA |
N | 207X00000X | Orthopaedic Surgeon | D0078710 | MD |
NPI | 1003880964 |
---|---|
Provider Name | Dr. Domenic Scalamogna |
First Address | Cordele, GA 31015-3254 |
Second Address | Newnan, GA 30265-2434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 10/06/2019 |