Provider Demographics
NPI:1255374625
Name:PAGE, DEXTER (MD)
Entity type:Individual
Prefix:DR
First Name:DEXTER
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE STREET, NE
Mailing Address - Street 2:SUITE 1275
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-872-3121
Mailing Address - Fax:404-872-3119
Practice Address - Street 1:550 PEACHTREE STREET, NE
Practice Address - Street 2:SUITE 1275
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-872-3121
Practice Address - Fax:404-872-3119
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040974207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000678906NMedicaid
GA000678906CMedicaid
GA000678906GMedicaid
GA000678906PMedicaid
GA000678906DMedicaid
GA000678906TMedicaid
GA000678906EMedicaid
GA000678906QMedicaid
GA000678906Medicaid
GA000678906HMedicaid
GA000678906AAMedicaid