Provider Demographics
NPI:1760644355
Name:PENN, DAVID ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ROSS
Last Name:PENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:860 PEACHTREE ST NE UNIT 1902
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1277
Mailing Address - Country:US
Mailing Address - Phone:954-560-1177
Mailing Address - Fax:
Practice Address - Street 1:1035 SOUTHCREST DR STE 250
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6117
Practice Address - Country:US
Practice Address - Phone:770-996-9945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2018-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC308152085R0202X
GA0726052085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology