Provider Demographics
NPI:1518541788
Name:DA COSTA, ADILSON (MD, MSC, PHD)
Entity Type:Individual
Prefix:
First Name:ADILSON
Middle Name:
Last Name:DA COSTA
Suffix:
Gender:M
Credentials:MD, MSC, PHD
Other - Prefix:DR
Other - First Name:ADILSON
Other - Middle Name:
Other - Last Name:DA COSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MSC, PHD
Mailing Address - Street 1:3780 HOLCOMB BRIDGE RD STE C
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4877
Mailing Address - Country:US
Mailing Address - Phone:770-263-9101
Mailing Address - Fax:
Practice Address - Street 1:3780 HOLCOMB BRIDGE RD STE C
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-4877
Practice Address - Country:US
Practice Address - Phone:770-263-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1190207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology