Healthcare Provider Details

I. General information

NPI: 1386694511
Provider Name (Legal Business Name): DAVID ASRAEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 UPPER RIVERDALE RD SW
RIVERDALE GA
30274-2615
US

IV. Provider business mailing address

6600 SUGARLOAF PKWY STE 400
DULUTH GA
30097-4345
US

V. Phone/Fax

Practice location:
  • Phone: 770-994-9326
  • Fax: 770-994-4747
Mailing address:
  • Phone: 678-821-2401
  • Fax: 678-821-2210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number051291
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: