Basic Information
| Provider Information | |||||||||
| NPI: | 1942492525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNDON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | B | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 724928 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 311391928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788381585 | ||||||||
| FaxNumber: | 6788381587 | ||||||||
| Practice Location | |||||||||
| Address1: | 6065 ROSWELL RD | ||||||||
| Address2: | SUITE 420 NORTHSIDE TOWER | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788381585 | ||||||||
| FaxNumber: | 6788381587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2007 | ||||||||
| LastUpdateDate: | 09/19/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.