Healthcare Provider Details

I. General information

NPI: 1629035092
Provider Name (Legal Business Name): DAVID WRUBEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5461 MERIDIAN MARK RD STE 520
ATLANTA GA
30342-3283
US

IV. Provider business mailing address

5461 MERIDIAN MARK RD STE 520
ATLANTA GA
30342-3283
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2900
  • Fax: 404-785-2930
Mailing address:
  • Phone: 404-785-2900
  • Fax: 404-785-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number56392
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: