Individual
DR. DAVID T DERRER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4550 COBB PARKWAY NORTH NW STE 101, ACWORTH, GA 30101
(470) 956-0100
(770) 529-0279
Mailing address
805 SANDY PLAINS ROAD, MEDICAL STAFF SERVICES, MARIETTA, GA 30066-6340
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
054181
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015928
BLUE CROSS/BLUE SHIELD #
GA
01
—
054181
GEORGIA MEDICAL LICENSE #
GA
Enumeration date
07/07/2005
Last updated
03/07/2023
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