Healthcare Provider Details

I. General information

NPI: 1578734364
Provider Name (Legal Business Name): DAVID H. DRUCKER, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 MEMORIAL DR STE 2
DALTON GA
30720-2577
US

IV. Provider business mailing address

1308 MEMORIAL DR STE 2
DALTON GA
30720-2577
US

V. Phone/Fax

Practice location:
  • Phone: 706-278-0880
  • Fax: 706-278-0859
Mailing address:
  • Phone: 706-278-0880
  • Fax: 706-278-0859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberGA19515
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number19515
License Number StateGA

VIII. Authorized Official

Name: DR. DAVID H DRUCKER
Title or Position: PHYSICIAN/ OWNER
Credential: M.D.
Phone: 706-278-0880