Healthcare Provider Details

I. General information

NPI: 1578526232
Provider Name (Legal Business Name): DAVID T HARVEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAVID T HARVEY MD

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 HIGHWAY 34 E STE B
NEWNAN GA
30265-1325
US

IV. Provider business mailing address

1615 HIGHWAY 34 E STE B
NEWNAN GA
30265-1325
US

V. Phone/Fax

Practice location:
  • Phone: 770-400-8400
  • Fax: 770-400-8401
Mailing address:
  • Phone: 770-400-8400
  • Fax: 770-400-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberN3719
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number31832
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberN3719
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberN3719
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number067639
License Number StateGA
# 6
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number067639
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: