Organization
OTIS PRESTIGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAMIAN DRAGO ARNP (ADMINISTRATOR)
(470) 301-8528
Entity
Organization
Contact information
Practice address
109 ANDERSON ST SE STE 200A, MARIETTA, GA 30060-8610
(470) 301-8528
Mailing address
55 ATLANTA ST SE STE 101, MARIETTA, GA 30060-1977
(470) 301-8528
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4703018528
4703018528
GA
Enumeration date
07/25/2022
Last updated
07/25/2022
Update your record
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