Provider Demographics
NPI:1487828661
Name:PAHL, DARRELL RYAN (NP)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:RYAN
Last Name:PAHL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 HOWELL FERRY RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3179
Mailing Address - Country:US
Mailing Address - Phone:678-473-4738
Mailing Address - Fax:678-473-4739
Practice Address - Street 1:3645 HOWELL FERRY RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3179
Practice Address - Country:US
Practice Address - Phone:678-473-4738
Practice Address - Fax:678-473-4739
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165166363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics