Healthcare Provider Details

I. General information

NPI: 1174600753
Provider Name (Legal Business Name): DAVID BENJAMIN MEYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/13/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 GLENLAKE PKWY CLENLAKE MEDICAL CENTER -DEPT. OF GASTROENTEROLOGY
ATLANTA GA
30328-3473
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 770-677-6085
  • Fax: 770-677-7343
Mailing address:
  • Phone: 404-949-5019
  • Fax: 404-364-4985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-113112
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number060936
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: