Individual
DR. DENNIS E DISANTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2675 N DECATUR RD, SUITE 506, DECATUR, GA 30033-6131
(404) 299-1679
(404) 508-7694
Mailing address
2675 N DECATUR RD, SUITE 506, DECATUR, GA 30033-6131
(404) 299-1679
(404) 508-7694
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
018138
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00110162A
—
GA
01
—
582322161
FEDERAL TAX ID
GA
Enumeration date
06/16/2006
Last updated
02/23/2010
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