MEDICARE: DR. DAVID T DERRER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	054181	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	054181	OTHER	GA	GEORGIA MEDICAL LICENSE #
2	015928	OTHER	GA	BLUE CROSS/BLUE SHIELD #

General Provider Information

NPI Number	:	1659378412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID T DERRER M.D.

Provider Business Mailing Address
First Line	:	805 SANDY PLAINS ROAD
Second Line	:	MEDICAL STAFF SERVICES
City	:	MARIETTA
State	:	GA
Zip	:	30066-6340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 COBB PARKWAY NORTH NW STE 101
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101
Country	:	US
Telephone Number	:	470-956-0100
Fax Number	:	770-529-0279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/07/2023

Similar Medicare Providers

1255296976 — EMILY FOWLER
Practice Location Address:

4550 COBB PARKWAY NORTH NW
ACWORTH, GA
30101-4180

Practice Phone: 470-956-0050
Practice Fax:

1699373928 — BOYD WILSON
Practice Location Address:

1685 MARS HILL RD NW STE 200
ACWORTH, GA
30101-7180

Practice Phone: 770-919-0930
Practice Fax:

1245192962 — MORGAN JOY SHORT
Practice Location Address:

2777 GLENKENCHIE CT NW
ACWORTH, GA
30101-8808

Practice Phone: 217-855-4122
Practice Fax:

1184617425 — PAMELA TINSLEY MD
Practice Location Address:

3501 BAKER RD NW STE 100
ACWORTH, GA
30101-3706

Practice Phone: 470-267-0620
Practice Fax: 770-999-2746

1831194968 — MS. FRANCES GEORGINA PATTERSON MS, APRN-C
Practice Location Address:

4791 S MAIN ST
ACWORTH, GA
30101-5324

Practice Phone: 770-422-1400
Practice Fax: 770-424-4382

1336146174 — DR. ROUL R SIRCAR M.D.
Practice Location Address:

4450 CALIBRE XING NW , SUITE 1224
ACWORTH, GA
30101-4103

Practice Phone: 770-974-6550
Practice Fax: 770-974-6551

Directions to “ DR. DAVID T DERRER M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.