Provider Demographics
NPI:1568766822
Name:DAVID B PHARIS MD PC
Entity Type:Organization
Organization Name:DAVID B PHARIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:PHARIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-622-6861
Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1407
Mailing Address - Country:US
Mailing Address - Phone:770-622-6861
Mailing Address - Fax:770-622-6862
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:770-622-6861
Practice Address - Fax:770-622-6862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045108207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00122847Medicare PIN
GADR1616Medicare PIN
GAP00906878Medicare PIN
GA202I072991Medicare PIN
GAH44008Medicare UPIN
GA202G702992Medicare PIN