Provider Demographics
NPI:1649899808
Name:MAHALLATI, DENA (MD, MBA)
Entity type:Individual
Prefix:
First Name:DENA
Middle Name:
Last Name:MAHALLATI
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ROCKY CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-6246
Mailing Address - Country:US
Mailing Address - Phone:770-778-6379
Mailing Address - Fax:
Practice Address - Street 1:120 ROCKY CREEK TRL
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-6246
Practice Address - Country:US
Practice Address - Phone:770-778-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program