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General NPI Number Information
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NPI Number | 1619236205
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Entity Type | Organization
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Legal Business Name | DAVID MEDICAL ENTERPRISES
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 3840 WATERS AVENUE I CARE FAMILY MEDICINE CLINIC
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City | SAVANNAH
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State | GA
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Zip | 31404-6264
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Country | US
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Telephone | 912-354-4239
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23955 MARC FREDERIQUE DAVID
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City | SAVANNAH
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State | GA
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Zip | 31403-3995
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Country | US
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Telephone | 912-354-4239
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Fax |
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Authorized Official
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Title or Position | CEO, DIRECT OWNER
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Name | MARC FREDERIQUE DAVID
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Credential | M.D.
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Telephone | 770-403-5382
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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 | 036.047838
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26091
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License Number State | GA
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