Provider Demographics
NPI:1215433305
Name:O'NEILL, DAVID ERIC (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ERIC
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 EAGLES LANDING PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5173
Mailing Address - Country:US
Mailing Address - Phone:770-506-4350
Mailing Address - Fax:770-506-9860
Practice Address - Street 1:1240 EAGLES LANDING PKWY STE 300
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5173
Practice Address - Country:US
Practice Address - Phone:770-506-4350
Practice Address - Fax:770-506-9860
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME160885207X00000X, 207XX0801X
390200000X
GA99384207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program