Provider Demographics
NPI:1750336046
Name:CARREIRA, DOMINIC S (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:S
Last Name:CARREIRA
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 1:2001 PEACHTREE RD NE STE 705
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1476
Mailing Address - Country:US
Mailing Address - Phone:404-355-0743
Mailing Address - Fax:855-270-3558
Practice Address - Street 1:1163 JOHNSON FERRY RD STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2764
Practice Address - Country:US
Practice Address - Phone:770-977-7777
Practice Address - Fax:404-355-2136
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0098607207X00000X
FLME98607207XX0004X, 207XX0005X
GA078584207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL90768OtherBCBS
FL278476900Medicaid
FL90768OtherBCBS
FLI38258Medicare UPIN