Healthcare Provider Details

I. General information

NPI: 1730290933
Provider Name (Legal Business Name): DAVID FREDERICK HERMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 SAVANNAH ST W SUITE A
TOCCOA GA
30577-2341
US

IV. Provider business mailing address

209 SAVANNAH ST W SUITE A
TOCCOA GA
30577-2341
US

V. Phone/Fax

Practice location:
  • Phone: 706-282-0779
  • Fax: 706-886-6471
Mailing address:
  • Phone: 706-282-0779
  • Fax: 706-886-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0039819
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: