Provider Demographics
NPI:1760429542
Name:FRANKLIN, DAVID LANCE (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LANCE
Last Name:FRANKLIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 RIVER N DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:770-512-0115
Mailing Address - Fax:770-512-0115
Practice Address - Street 1:180 RIVER N DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-992-1882
Practice Address - Fax:770-512-0115
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002459367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA199990131CMedicaid
GA199990131DMedicaid
P00175062OtherRAILROAD MEDICARE
GAN348874OtherWELLCARE
GA32BBBDTMedicare PIN
P00175062OtherRAILROAD MEDICARE