Individual
DAVID A RETBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7316 SPOUT SPRINGS RD STE 203, FLOWERY BRANCH, GA 30542-5620
(678) 205-8387
(678) 808-1039
Mailing address
1930 BRANNAN RD, MCDONOUGH, GA 30253-4310
(678) 284-4040
(678) 284-4076
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9308
GA
363A00000X
Physician Assistant
PA2009-0013
NM
363AM0700X
Medical Physician Assistant
PA2009-0013
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2009-0013
NM LICENSE
NM
Enumeration date
10/30/2007
Last updated
08/30/2019
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