Provider Demographics
NPI:1427194224
Name:SUGERMAN, DAVID EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:SUGERMAN
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 1:210 E HILL ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4372
Mailing Address - Country:US
Mailing Address - Phone:470-792-1223
Mailing Address - Fax:
Practice Address - Street 1:531 ASBURY CIR STE N340
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0020
Practice Address - Country:US
Practice Address - Phone:404-778-5975
Practice Address - Fax:404-778-2630
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2021-11-06
Deactivation Date:2021-10-28
Deactivation Code:
Reactivation Date:2021-11-06
Provider Licenses
StateLicense IDTaxonomies
MDT4088207P00000X
GA63030207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine