Dercola, John Carmen
Dercola, John Carmen is an individual health care provider with primary practice located at 55 Whitcher St Ne Suite 350, Marietta GA 30060-1155. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Dercola, John Carmen can be contacted via phone (770) 424-6893.Contact Information
Primary practice address
55 Whitcher St Ne Suite 350
Marietta GA 30060-1155
Phone: (770) 424-6893
Fax: (770) 528-9926
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 002707 | Georgia |
Profile Details
| NPI number | 1417952433 |
|---|---|
| LBN Legal business name | Dercola, John Carmen |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 16th, 2005 |
| Last updated | Jan 2nd, 2013 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1417952433 | NPPES |
| Georgia | MEDICAID | 100001072G | |
| Georgia | MEDICAID | 100001072F- | |
| Georgia | MEDICAID | 100001073B | |
| Georgia | MEDICAID | 100001073C | |
| Georgia | MEDICAID | 100001072H |
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