Healthcare Provider Details

I. General information

NPI: 1477641710
Provider Name (Legal Business Name): DAVID HARRY FAGIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

645 WATER GARDEN WAY
ROSWELL GA
30075-7135
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2275
  • Fax: 404-785-4961
Mailing address:
  • Phone: 770-619-9450
  • Fax: 770-619-9450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number028765
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: