Provider Demographics
NPI:1588659908
Name:PAUL, DARA (MD)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3890 REDWINE RD SW
Mailing Address - Street 2:STE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5509
Mailing Address - Country:US
Mailing Address - Phone:404-346-3417
Mailing Address - Fax:404-346-3418
Practice Address - Street 1:3890 REDWINE RD SW
Practice Address - Street 2:STE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5509
Practice Address - Country:US
Practice Address - Phone:404-346-3417
Practice Address - Fax:404-346-3418
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA055417174400000X
GA55417207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH50021Medicare UPIN