person
John Carmen Dercola, PA
Medical Physician Assistant in Marietta, Georgia
NPI 1417952433

John Carmen Dercola is a Medical Physician Assistant based in Marietta, GA and is specialized in Medical. John Carmen Dercola practices in Marietta, GA and has the professional credentials of PA. The NPI Number for John Carmen Dercola is 1417952433 and holds a License No. 002707 (Georgia).

The current practice location address for John Carmen Dercola is 55 Whitcher St Ne, Marietta, GA and can be reached out via phone at 770-424-6893 and via fax at 770-528-9926.

Location: 55 Whitcher St Ne, Marietta, GA, 30060-1155
person
Provider Profile Details
NPI Number
1417952433
Provider Name
John Carmen Dercola
Credential
PA
Provider Entity Type
Individual
Gender
Male
Address
55 Whitcher St Ne, Marietta, GA, 30060-1155
Phone Number
770-424-6893
Fax Number
770-528-9926
Provider Enumeration Date
06/16/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
100001072G 05 GA
100001072F- 05 GA
100001073B 05 GA
100001073C 05 GA
100001072H 05 GA
institution
Provider Business Practice Location Address Details
Address
55 Whitcher St Ne
City
State
Zip
30060-1155
Phone Number
770-424-6893
Fax Number
770-528-9926
person
Provider Business Mailing Address Details
Address
55 Whitcher St Ne
City
State
Zip
30060-1155
Phone Number
770-424-6893
Fax Number
770-528-9926
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
002707 (Georgia)
Definition
Definition to come...
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