Provider Demographics
NPI:1881202752
Name:ZANDOC GROUP CORP
Entity type:Organization
Organization Name:ZANDOC GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARIELLYS
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:678-668-1173
Mailing Address - Street 1:2759 DELK RD SE STE 1603
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8887
Mailing Address - Country:US
Mailing Address - Phone:678-668-1173
Mailing Address - Fax:
Practice Address - Street 1:2759 DELK RD SE STE 1603
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8887
Practice Address - Country:US
Practice Address - Phone:678-668-1173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA279474230BMedicaid