Healthcare Provider Details

I. General information

NPI: 1659516326
Provider Name (Legal Business Name): RYAN PATRICK FAGAN M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CLIFTON ROAD NE BUILDING 1, MS D-63
ATLANTA GA
30333
US

IV. Provider business mailing address

1600 CLIFTON ROAD NE BUILDING 1, MS D-63
ATLANTA GA
30333
US

V. Phone/Fax

Practice location:
  • Phone: 404-708-1154
  • Fax: 404-639-3535
Mailing address:
  • Phone: 404-708-1154
  • Fax: 404-639-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.15556R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD.15556R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: