Healthcare Provider Details

I. General information

NPI: 1730249905
Provider Name (Legal Business Name): DAVID A PALAY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 GLENRIDGE DR NE SUITE 120
ATLANTA GA
30328-6141
US

IV. Provider business mailing address

5730 GLENRIDGE DR NE SUITE 120
ATLANTA GA
30328-6141
US

V. Phone/Fax

Practice location:
  • Phone: 404-252-1194
  • Fax: 404-252-3150
Mailing address:
  • Phone: 404-252-1194
  • Fax: 404-252-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number31304
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: