Provider Demographics
NPI:1114385820
Name:DUNWOODY MEDICAL GROUP
Entity Type:Organization
Organization Name:DUNWOODY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BELL-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-443-4000
Mailing Address - Street 1:2452 SPENCERS WAY
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1252
Mailing Address - Country:US
Mailing Address - Phone:678-570-2211
Mailing Address - Fax:
Practice Address - Street 1:5901 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE C25
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5382
Practice Address - Country:US
Practice Address - Phone:678-443-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031204208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty