Provider Demographics
NPI:1447559604
Name:CASEY, DAVID BRENDAN (MD/PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRENDAN
Last Name:CASEY
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 TREE LN STE 190
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6766
Mailing Address - Country:US
Mailing Address - Phone:770-736-6300
Mailing Address - Fax:
Practice Address - Street 1:1700 TREE LN STE 100
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6749
Practice Address - Country:US
Practice Address - Phone:770-736-6300
Practice Address - Fax:678-639-3958
Is Sole Proprietor?:No
Enumeration Date:2011-03-26
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.205849208D00000X
GA080884207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2150049Medicaid