Healthcare Provider Details

I. General information

NPI: 1629338454
Provider Name (Legal Business Name): DAVID HOUGHTON SNIADACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2012
Last Update Date: 05/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CLIFTON RD NE MAILSTOP A-04
ATLANTA GA
30329-4018
US

IV. Provider business mailing address

1600 CLIFTON RD NE MAILSTOP A-04
ATLANTA GA
30329-4018
US

V. Phone/Fax

Practice location:
  • Phone: 404-639-8252
  • Fax:
Mailing address:
  • Phone: 404-639-8252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34952
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: