Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 028765 | GA |
NPI | 1477641710 |
---|---|
Provider Name | David Harry Fagin |
First Address | Roswell, GA 30075-7135 |
Second Address | Atlanta, GA 30342-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |