Individual
DORA PATRICIA DOMINGUEZ DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1412 MILSTEAD AVE NE, CONYERS, GA 30012-3877
(770) 918-3000
Mailing address
2800 MAIN ST, BRIDGEPORT, CT 06606-4201
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
077725
GA
208M00000X
Hospitalist Physician
Primary
077725
GA
Other
Enumeration date
07/17/2014
Last updated
09/23/2021
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