Provider Demographics
NPI:1851373740
Name:DLUGOS, DINA FORSTHOFFER (PA-C)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:FORSTHOFFER
Last Name:DLUGOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3460
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0059
Mailing Address - Country:US
Mailing Address - Phone:678-957-8801
Mailing Address - Fax:678-957-8804
Practice Address - Street 1:3400 MCCLURE BRIDGE RD
Practice Address - Street 2:B201
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6675
Practice Address - Country:US
Practice Address - Phone:678-957-8801
Practice Address - Fax:678-957-8804
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003394363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA754463940AMedicaid