Provider Demographics
NPI:1942492525
Name:HERNDON, DAVID B
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:HERNDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 724928
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-1928
Mailing Address - Country:US
Mailing Address - Phone:678-838-1585
Mailing Address - Fax:678-838-1587
Practice Address - Street 1:6065 ROSWELL RD
Practice Address - Street 2:SUITE 420 NORTHSIDE TOWER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:678-838-1585
Practice Address - Fax:678-838-1587
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies