Provider Demographics
NPI:1013094184
Name:FIELDS, DAVID ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALBERT
Last Name:FIELDS
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:PO BOX 724928
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-9028
Mailing Address - Country:US
Mailing Address - Phone:678-838-1585
Mailing Address - Fax:678-838-1587
Practice Address - Street 1:96 TARA COMMONS DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-8031
Practice Address - Country:US
Practice Address - Phone:770-554-0399
Practice Address - Fax:770-554-0058
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBXDJMedicare ID - Type UnspecifiedMEDICARE #
GAH08243Medicare UPIN