Individual
DOMINIQUE DAIELLE PEART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-1000
Mailing address
4611 SAYBROOK DR, NORCROSS, GA 30093-4741
(229) 395-6524
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
207725
GA
367500000X
Certified Registered Nurse Anesthetist
Primary
207725
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207725
GEORGIA SECRETARY OF STATE
GA
Enumeration date
03/20/2018
Last updated
04/02/2024
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