Individual
JOHN CARMEN DERCOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(770) 528-9926
Mailing address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(770) 528-9926
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
002707
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001072F-
—
GA
05
—
100001072G
—
GA
05
—
100001072H
—
GA
05
—
100001073B
—
GA
05
—
100001073C
—
GA
Enumeration date
06/16/2005
Last updated
01/02/2013
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