Healthcare Provider Details

I. General information

NPI: 1871608489
Provider Name (Legal Business Name): DAVID WAYNE MARKHAM MD, MSC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1267 HIGHWAY 54 W STE 2200
FAYETTEVILLE GA
30214-2110
US

IV. Provider business mailing address

5673 PEACHTREE DUNWOODY RD SUITE 650
ATLANTA GA
30342-1731
US

V. Phone/Fax

Practice location:
  • Phone: 770-716-0051
  • Fax:
Mailing address:
  • Phone: 678-843-5801
  • Fax: 678-843-7746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number69311
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number69311
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: