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Contact Information

OTIS PRESTIGE
109 ANDERSON ST SE STE 200A
MARIETTA, GA30060-8610
 Phone: 470-301-8528
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Infectious Disease

207RI0200X 11 Physician/Internal Medicine
 

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for OTIS PRESTIGE

NPI Number 1992431753
LBN Legal business name OTIS PRESTIGE
Authorized official DAMIAN DRAGO - (ADMINISTRATOR)
Entity Organization
Organization subpart 1 No
Enumeration date 07/25/2022
Last updated 07/25/2022 - About 4 years ago
Identifiers
GA Other 4703018528 4703018528
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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