Provider Demographics
NPI:1851449649
Name:ROYAL, DINA K (MD)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:K
Last Name:ROYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 POST OAK TRITT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8620
Mailing Address - Country:US
Mailing Address - Phone:770-973-4700
Mailing Address - Fax:
Practice Address - Street 1:2155 POST OAK TRITT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8620
Practice Address - Country:US
Practice Address - Phone:770-973-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01724208000000X
CAA62559208000000X
GA062765208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC147VWOtherBCBS
CA00A625590Medicaid
NC5908597Medicaid
CA00A625590Medicaid