Provider Demographics
NPI:1952385254
Name:DINATTI, LOUIS A (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:A
Last Name:DINATTI
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 1:20 RIVERBEND DR SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-6066
Mailing Address - Country:US
Mailing Address - Phone:706-295-0070
Mailing Address - Fax:706-235-1618
Practice Address - Street 1:20 RIVERBEND DR SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-6066
Practice Address - Country:US
Practice Address - Phone:706-295-0070
Practice Address - Fax:706-235-1618
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049774208600000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00898125AMedicaid
TN1519423Medicaid
GA02BBCPGMedicare ID - Type Unspecified