Provider Demographics
NPI:1346402088
Name:FISHER, DAVID ROBERT CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROBERT CHARLES
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 COLUMBIA RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1450
Mailing Address - Country:US
Mailing Address - Phone:706-863-1440
Mailing Address - Fax:706-863-5418
Practice Address - Street 1:4106 COLUMBIA RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1450
Practice Address - Country:US
Practice Address - Phone:706-863-1440
Practice Address - Fax:706-863-5418
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA066368208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003107241AMedicaid