Dante C Adan, MD
Individual provider Active NPI Pediatrics Physician · Kennesaw, GA
NPI 1497724330 · NPPES record last updated Jan 13, 2022
Key facts
- NPI
- 1497724330
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 056952 (GA)
- Practice address
- 750 Townpark LN NW
Townpark Medical Center Dept of Pediatrics
Kennesaw, GA 30144-5579 - Phone
- (770) 514-5401
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051116000755 | GA | Practitioner - Pediatric Medicine | 7810916079 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Southeast Permanente Medical Group | Pediatrics | Current |
Accepting new patients |
Locations
3550 Preston Ridge Rd
Alpharetta, GA 30005
Phone (770) 663-3122
3495 Piedmont Rd NE
Bldg 9
Atlanta, GA 30305
Phone (404) 364-7000
750 Townpark Ln NW
Kennesaw, GA 30144
Phone (770) 514-5401
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 056952 | GA | Yes |
Addresses
Primary practice location
750 Townpark LN NW
Townpark Medical Center Dept of Pediatrics
Kennesaw, GA 30144-5579
Mailing address
3495 Piedmont Rd NE
Nine Piedmont Center
Atlanta, GA 30305-1717
Phone (404) 949-5019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 947532165A | Medicaid | GA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq | Health Information Exchange (HIE) | Permanente Medical Group |
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All providers in Kennesaw, GA · Pediatrics Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.