Provider Demographics
NPI:1750305124
Name:BOAZ, DAVID SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SAMUEL
Last Name:BOAZ
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1845 LOCKEWAY DR
Mailing Address - Street 2:SUITE 404
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5936
Mailing Address - Country:US
Mailing Address - Phone:770-343-9112
Mailing Address - Fax:770-343-8911
Practice Address - Street 1:1845 LOCKEWAY DR
Practice Address - Street 2:SUITE 404
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-5936
Practice Address - Country:US
Practice Address - Phone:770-343-9112
Practice Address - Fax:770-343-8911
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-10-17
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Provider Licenses
StateLicense IDTaxonomies
GA048486207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G87932Medicare UPIN
GA08BBRNKMedicare PIN