Provider Demographics
NPI:1003880964
Name:SCALAMOGNA, DOMENIC (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:
Last Name:SCALAMOGNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 1700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3087
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:2201 NEWNAN CROSSING BLVD E STE 100
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2551
Practice Address - Country:US
Practice Address - Phone:770-460-4747
Practice Address - Fax:678-673-5102
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233236207X00000X
MDD0078710207X00000X
GA69632207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery