MEDICARE: DR. DAVID W PUMPHREY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	9964	GA

General Provider Information

NPI Number	:	1598985475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID W PUMPHREY

Provider Business Mailing Address
First Line	:	300 W WIEUCA RD NE
Second Line	:	BLDG 2 SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30342-3352
Country	:	US
Telephone Number	:	404-303-1200
Fax Number	:	404-303-9224

Provider Business Practice Location Address
First Line	:	300 W WIEUCA RD NE
Second Line	:	BLDG 2 SUITE 100
City	:	ATLANTA
State	:	GA
Zip	:	30342-3352
Country	:	US
Telephone Number	:	404-303-1200
Fax Number	:	404-303-9224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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