Healthcare Provider Details

I. General information

NPI: 1568766822
Provider Name (Legal Business Name): DAVID B PHARIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 08/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PLEASANT HILL RD SUITE 200
DULUTH GA
30096-1407
US

IV. Provider business mailing address

3855 PLEASANT HILL RD SUITE 200
DULUTH GA
30096-1407
US

V. Phone/Fax

Practice location:
  • Phone: 770-622-6861
  • Fax: 770-622-6862
Mailing address:
  • Phone: 770-622-6861
  • Fax: 770-622-6862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number045108
License Number StateGA

VIII. Authorized Official

Name: DAVID B PHARIS
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 770-622-6861