Healthcare Provider Details

I. General information

NPI: 1952450918
Provider Name (Legal Business Name): DAVID KEITH ZOLLINGER P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/07/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DOCTORS WAY
BLAIRSVILLE GA
30512
US

IV. Provider business mailing address

35 HOSPITAL RD
BLAIRSVILLE GA
30512-3139
US

V. Phone/Fax

Practice location:
  • Phone: 706-439-6858
  • Fax:
Mailing address:
  • Phone: 706-745-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4160
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: