Basic Information
| Provider Information | |||||||||
| NPI: | 1447559604 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASEY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BRENDAN | ||||||||
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| Credential: | MD/PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 TREE LN STE 190 | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300786766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707366300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1700 TREE LN STE 100 | ||||||||
| Address2: | |||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300786749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707366300 | ||||||||
| FaxNumber: | 6786393958 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2011 | ||||||||
| LastUpdateDate: | 01/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208D00000X | MD.205849 | LA | N | Allopathic & Osteopathic Physicians | General Practice | 207RI0011X | 080884 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 2150049 | 05 | LA | MEDICAID |