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Stanley H Dysart
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NPI Number Detailed Information
Provider Information:
| Name: | Stanley H Dysart |
| Gender: | M |
| Provider License Number If Given: | 31591 |
NPI Information:
| NPI: | 1578566527 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 5/23/2005 |
| Last Update Date: | 12/5/2013 |
Provider Business Mailing Address:
| Address: | 300 TOWER RD NE STE 200 Marietta, GA 30060 |
| Phone Number: | 7704275717 |
| Fax Number: | 7704296503 |
Provider Business Practice Location Address:
| Address: | 300 TOWER RD NE STE 200 Marietta, GA 30060 |
| Phone Number: | 7704275717 |
| Fax Number: | 7704296503 |
Provider Taxonomy:
| Primary: | 207X00000X |
| Secondary (if any): | |
| State: | GA |
