Provider Demographics
NPI:1699951921
Name:LIFF, DAVID AUSTIN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:AUSTIN
Last Name:LIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1436 BROADRICK DR STE B
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3009
Mailing Address - Country:US
Mailing Address - Phone:706-226-3434
Mailing Address - Fax:706-226-4820
Practice Address - Street 1:1436 BROADRICK DR STE B
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3009
Practice Address - Country:US
Practice Address - Phone:706-226-3434
Practice Address - Fax:706-226-4820
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0059997207RI0011X
GA60758207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2197622Medicaid
MS00686093Medicaid
MS00686093Medicaid