Provider Demographics
NPI:1851452254
Name:VAN, DAVID ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ARTHUR
Last Name:VAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 S HILL ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4830
Mailing Address - Country:US
Mailing Address - Phone:770-228-5407
Mailing Address - Fax:770-227-1430
Practice Address - Street 1:747 S HILL ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4830
Practice Address - Country:US
Practice Address - Phone:770-228-5407
Practice Address - Fax:770-227-1430
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00391377AMedicaid
GA2723329P01OtherCIGNA PROVIDER NUMBER
GA52023547OtherBCBS PROVIDER NUMBER
GAD41276Medicare UPIN