Healthcare Provider Details

I. General information

NPI: 1215433305
Provider Name (Legal Business Name): DAVID ERIC O'NEILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 EAGLES LANDING PKWY STE 300
STOCKBRIDGE GA
30281-5173
US

IV. Provider business mailing address

1240 EAGLES LANDING PKWY STE 300
STOCKBRIDGE GA
30281-5173
US

V. Phone/Fax

Practice location:
  • Phone: 770-506-4350
  • Fax: 770-506-9860
Mailing address:
  • Phone: 770-506-4350
  • Fax: 770-506-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME160885
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberME160885
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number99384
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: