Healthcare Provider Details

I. General information

NPI: 1861435364
Provider Name (Legal Business Name): DAVID JOHN ROSENFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/08/2021
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 ADAMS ST NE STE B
COVINGTON GA
30014-6209
US

IV. Provider business mailing address

3390 PEACHTREE RD NE STE 1500
ATLANTA GA
30326-2822
US

V. Phone/Fax

Practice location:
  • Phone: 770-929-9033
  • Fax:
Mailing address:
  • Phone: 404-920-4950
  • Fax: 404-920-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number022356
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTP454
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberTP454
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberTP454
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number63728
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: