Provider Demographics
NPI:1578526232
Name:HARVEY, DAVID T (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:T
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:T
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1615 HIGHWAY 34 E STE B
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1325
Mailing Address - Country:US
Mailing Address - Phone:770-400-8400
Mailing Address - Fax:770-400-8401
Practice Address - Street 1:1615 HIGHWAY 34 E STE B
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1325
Practice Address - Country:US
Practice Address - Phone:770-400-8400
Practice Address - Fax:770-400-8401
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3719207N00000X, 207ND0101X, 207NS0135X
AL31832207N00000X
GA067639207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1396087680OtherGROUP NUMBER
GA202G708673OtherGROUP PTAN
FL012356200Medicaid
AL510G700457Medicare PIN
GA1396087680OtherGROUP NUMBER