Individual
DR. DAVID MACY VIDRINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
80 LACY ST NW, MARIETTA, GA 30060-1112
(770) 427-0368
(678) 581-5969
Mailing address
PO BOX 23781, NEW YORK, NY 10087-3781
(770) 427-0368
(678) 581-5969
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
109818
GA
207YP0228X
Pediatric Otolaryngology Physician
226983
MA
207YP0228X
Pediatric Otolaryngology Physician
30117
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
301177
—
SC
01
—
DE5192
UNSPECIFIED
SC
Enumeration date
06/13/2006
Last updated
05/04/2026
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