MEDICARE: BRIAN DERBY 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	208200000X	Plastic Surgery Physician	70085	GA

General Provider Information

NPI Number	:	1841499266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN DERBY M.D.

Provider Business Mailing Address
First Line	:	1750 COMMERCE DR NW APT 3120
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-3178
Country	:	US
Telephone Number	:	954-270-7530
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 HOWELL MILL RD NW STE 140
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-0916
Country	:	US
Telephone Number	:	404-351-4151
Fax Number	:	404-351-4152

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	08/12/2013

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Directions to “ BRIAN DERBY M.D.” Practice Location

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