Organization
S.T.R OF GEORGIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIMMIE DOMINIC DANCER M.D. (OWNER)
(404) 367-3014
Entity
Organization
Contact information
Practice address
35 COLLIER RD NW STE 635, ATLANTA, GA 30309-1611
(404) 367-3014
Mailing address
2566 SHALLOWFORD RD NE, SUITE 104 PBM 329, ATLANTA, GA 30345-0000
(404) 367-3014
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
11/11/2008
Last updated
11/19/2008
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