Provider Demographics
NPI:1912098435
Name:D'HEURLE, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:D'HEURLE
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 1:3619 HADDEN HALL RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2627
Mailing Address - Country:US
Mailing Address - Phone:404-365-8707
Mailing Address - Fax:
Practice Address - Street 1:1720 PEACHTREE ST NW
Practice Address - Street 2:SUITE 932
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2449
Practice Address - Country:US
Practice Address - Phone:404-351-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026096207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52291515001OtherBC/BS
GA2384694OtherAETNA
GA180040998OtherRR MEDICARE
GA00284501EMedicaid
GA3383779OtherCIGNA
GAWFC13OtherEMPIRE BC
GA52291515001OtherBC/BS
GAGRP4784Medicare ID - Type Unspecified