Provider Demographics
NPI:1942305164
Name:BANKS, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:BANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1930 BRANNAN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4310
Mailing Address - Country:US
Mailing Address - Phone:678-284-4040
Mailing Address - Fax:678-284-4076
Practice Address - Street 1:1357 HEMBREE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5722
Practice Address - Country:US
Practice Address - Phone:770-475-7550
Practice Address - Fax:770-343-9080
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA021941208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000229809BMedicaid
GAGRP1552Medicare PIN
D39345Medicare UPIN