Healthcare Provider Details

I. General information

NPI: 1457350498
Provider Name (Legal Business Name): DAVID B. AUSTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 ALCOVY ST WRMC - ANESTHESIOLOGY
MONROE GA
30655-2140
US

IV. Provider business mailing address

330 ALCOVY ST WRMC - ANESTHESIOLOGY
MONROE GA
30655-2140
US

V. Phone/Fax

Practice location:
  • Phone: 770-267-8461
  • Fax:
Mailing address:
  • Phone: 770-267-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number78892
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number29577
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: