Healthcare Provider Details

I. General information

NPI: 1275539470
Provider Name (Legal Business Name): DAVID L. PERLOW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/22/2006

III. Provider practice location address

2520 WINDY HILL RD SE STE 305
MARIETTA GA
30067-8653
US

IV. Provider business mailing address

2520 WINDY HILL RD SE STE 305
MARIETTA GA
30067-8653
US

V. Phone/Fax

Practice location:
  • Phone: 770-951-0866
  • Fax: 770-933-0209
Mailing address:
  • Phone: 770-951-0866
  • Fax: 770-933-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number025014
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25014
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: