Provider Demographics
NPI:1487804001
Name:DALTON, LONNIE C (DO)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:C
Last Name:DALTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6124 KINGS MOUNTAIN CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1920
Mailing Address - Country:US
Mailing Address - Phone:770-923-1629
Mailing Address - Fax:770-921-5626
Practice Address - Street 1:6124 KINGS MOUNTAIN CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1920
Practice Address - Country:US
Practice Address - Phone:770-923-1629
Practice Address - Fax:770-921-5626
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA13368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine