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General NPI Number Information
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NPI Number | 1114981081
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Entity Type | Organization
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Legal Business Name | DAVID A FIELDS MD FAMILY CARE PC
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 02/15/2008
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Provider Practice Location Address
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Address Line | 96 TARA COMMONS DR
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City | LOGANVILLE
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State | GA
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Zip | 30052-8031
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Country | US
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Telephone | 770-554-0399
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Fax | 770-554-0058
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Provider Business Mailing Address
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Address Line | PO BOX 724928
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City | ATLANTA
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State | GA
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Zip | 31139-9028
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Country | US
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Telephone | 770-554-0399
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Fax | 770-554-0058
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KELLY GADDIS
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Credential |
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Telephone | 770-554-0399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 048232
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License Number State | GA
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