Provider Demographics
NPI:1902973928
Name:SALTZMAN, DAVID M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:SALTZMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4954 KINGSBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-6922
Mailing Address - Country:US
Mailing Address - Phone:770-919-1295
Mailing Address - Fax:
Practice Address - Street 1:1515 WESTFORK DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122
Practice Address - Country:US
Practice Address - Phone:770-739-2278
Practice Address - Fax:770-739-2279
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001463103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA62TCCFCMedicare ID - Type Unspecified
GAR12547Medicare UPIN