Provider Demographics
NPI:1841499266
Name:DERBY, BRIAN (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:DERBY
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 1:1750 COMMERCE DR NW APT 3120
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-3178
Mailing Address - Country:US
Mailing Address - Phone:954-270-7530
Mailing Address - Fax:
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 140
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-0916
Practice Address - Country:US
Practice Address - Phone:404-351-4151
Practice Address - Fax:404-351-4152
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70085208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery