Individual
MARY DYAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1310 TAYLOR SPRINGS RD, VIDALIA, GA 30474-6521
(912) 537-0081
Mailing address
1310 TAYLOR SPRINGS RD, VIDALIA, GA 30474-6521
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
18891
GA
Other
Enumeration date
06/29/2010
Last updated
06/29/2010
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