Provider Demographics
NPI:1437263704
Name:OMMERT, DENNIS PAUL (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:PAUL
Last Name:OMMERT
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 1:285 GLADESIDE PATH
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1552
Mailing Address - Country:US
Mailing Address - Phone:678-710-5747
Mailing Address - Fax:
Practice Address - Street 1:285 GLADESIDE PATH
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1552
Practice Address - Country:US
Practice Address - Phone:678-710-5747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106075207R00000X
GA87826207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C43324Medicare UPIN