Provider Demographics
NPI:1659351906
Name:DILLARD, KARIN DIPIETRO (MD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:DIPIETRO
Last Name:DILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:RENEE
Other - Last Name:DIPIETRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:725 JESSE JEWELL PKWY SE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3834
Practice Address - Country:US
Practice Address - Phone:770-297-2200
Practice Address - Fax:770-534-8139
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038468207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0700329OtherUNITED HEALTHCARE
GA160029735OtherRR MEDICARE-GRP # CC4177
GA52494260OtherBCBS
GA10045046OtherAMERIGROUP
GA000610772BMedicaid
GA341060OtherWELLCARE
GA7678678OtherCIGNA
GA10045046OtherAMERIGROUP
GA341060OtherWELLCARE