JOHN CARMEN DERCOLA PA NPI 1417952433

NPI Information

John Carmen Dercola, PA is a medical physician assistant in Marietta, GA with 39 years of experience. John Carmen Dercola, PA NPI is 1417952433. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: HAHNEMANN UNIVERSITY COLLEGE OF MEDICINE
Graduation Year:1985

The provider's business location address is:

55 WHITCHER ST NE
SUITE 350
MARIETTA, GA
ZIP 30060-155
Phone: (770) 424-6893
Fax: (770) 528-9926

The NPI 1417952433 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/16/2005 and was last updated on 1/2/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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