Provider Demographics
NPI:1275539470
Name:PERLOW, DAVID L (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:PERLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WINDY HILL RD SE
Mailing Address - Street 2:STE 305
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8653
Mailing Address - Country:US
Mailing Address - Phone:770-951-0866
Mailing Address - Fax:770-933-0209
Practice Address - Street 1:2520 WINDY HILL RD SE
Practice Address - Street 2:STE 305
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8653
Practice Address - Country:US
Practice Address - Phone:770-951-0866
Practice Address - Fax:770-933-0209
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2018-04-09
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-22
Provider Licenses
StateLicense IDTaxonomies
GA025014174400000X
GA25014208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA340002346OtherMEDICARE RR
GA7280346OtherAETNA
GA00266417AMedicaid
GA34BDDKNMedicare PIN
GA340002346OtherMEDICARE RR