Basic Information
| Provider Information | |||||||||
| NPI: | 1386694511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ASRAEL | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 SUGARLOAF PKWY | ||||||||
| Address2: | STE 400 | ||||||||
| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300974345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788212401 | ||||||||
| FaxNumber: | 6788212210 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 UPPER RIVERDALE RD SW | ||||||||
| Address2: | |||||||||
| City: | RIVERDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302742615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709949326 | ||||||||
| FaxNumber: | 7709944747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 051291 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 000955963H | 05 | GA | MEDICAID |