Provider Demographics
NPI:1932284833
Name:OWENS, DAVID SMITH (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SMITH
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4545 HARRIS TRL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-3813
Mailing Address - Country:US
Mailing Address - Phone:404-277-1502
Mailing Address - Fax:404-420-2805
Practice Address - Street 1:4545 HARRIS TRL NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-3813
Practice Address - Country:US
Practice Address - Phone:404-277-1502
Practice Address - Fax:404-420-2805
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0340372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0005444970Medicaid
GA0005444970Medicaid
GAF56760Medicare UPIN