Provider Demographics
NPI:1568676823
Name:PACK, DAVID K (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:PACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4432 DERWENT DR NE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1986
Mailing Address - Country:US
Mailing Address - Phone:770-992-4621
Mailing Address - Fax:770-992-4621
Practice Address - Street 1:6185 BUFORD HWY BLDG G
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-2350
Practice Address - Country:US
Practice Address - Phone:770-446-0929
Practice Address - Fax:770-446-6977
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2014-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA18829225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA25BBFTWMedicare ID - Type Unspecified